(Circulation. 1995;91:1022-1028.)
© 1995 American Heart Association, Inc.
Articles |
Valve Repair Improves the Outcome of Surgery for Mitral Regurgitation
A Multivariate Analysis
From the Division of Cardiovascular Diseases and Internal Medicine (M.E.-S., A.J.T., R.L.F.), Section of Cardiovascular Surgery (H.V.S., T.A.O.), and Section of Biostatistics (K.R.B.), Mayo Clinic and Mayo Foundation, Rochester, Minn.
Background Mitral valve repair has been suggested as providing a better postoperative outcome than valve replacement for mitral regurgitation, but this impression has been obscured by differences in baseline characteristics and has not been confirmed in multivariate analyses.
Methods and Results The outcomes in 195 patients with valve repair and 214 with replacement for organic mitral regurgitation were compared using multivariate analysis. All patients had preoperative echocardiographic assessment of left ventricular function. Before surgery, patients with valve repair were less symptomatic than those with replacement (42% in New York Heart Association functional class I or II versus 24%, respectively; P=.001), had less atrial fibrillation (41% versus 53%; P=.017), and had a better ejection fraction (63±9% versus 60±12%, P=.016). After valve repair, compared with valve replacement, overall survival at 10 years was 68±6% versus 52±4% (P=.0004), overall operative mortality was 2.6% versus 10.3% (P=.002), operative mortality in patients under age 75 was 1.3% versus 5.7% (P=.036), and late survival (in operative survivors) at 10 years was 69±6% versus 58±5% (P=.018). Late survival after valve repair was not different from expected survival. After surgery, ejection fraction decreased significantly in both groups but was higher after valve repair (P=.001). Multivariate analysis indicated an independent beneficial effect of valve repair on overall survival (hazard ratio, 0.39; P=.00001), operative mortality (odds ratio, 0.27; P=.026), late survival (hazard ratio, 0.44; P=.001), and postoperative ejection fraction (P=.001).
Conclusions Valve repair significantly improves postoperative outcome in patients with mitral regurgitation and should be the preferred mode of surgical correction. The low operative mortality is an incentive for early surgery before ventricular dysfunction occurs.
Key Words: mitral valve • prognosis • ventricles • myocardium • surgery
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T. A. Vassiliades Jr, P. C. Block, L. H. Cohn, D. H. Adams, J. S. Borer, T. Feldman, D. R. Holmes, W. K. Laskey, B. W. Lytle, M. J. Mack, et al. The Clinical Development of Percutaneous Heart Valve Technology: A Position Statement of The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), and the Society for Cardiovascular Angiography and Interventions (SCAI) Ann. Thorac. Surg., May 1, 2005; 79(5): 1812 - 1818. [Full Text] [PDF]
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S. Talwar, M. R. Rajesh, A. Subramanian, A. Saxena, and A. S. Kumar Mitral valve repair in children with rheumatic heart disease J. Thorac. Cardiovasc. Surg., April 1, 2005; 129(4): 875 - 879. [Abstract] [Full Text] [PDF]
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A. H. Wu, K. D. Aaronson, S. F. Bolling, F. D. Pagani, K. Welch, and T. M. Koelling Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction J. Am. Coll. Cardiol., February 1, 2005; 45(3): 381 - 387. [Abstract] [Full Text] [PDF]
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H.P. Kuhl and P. Hanrath The impact of transesophageal echocardiography on daily clinical practice Eur J Echocardiogr, December 1, 2004; 5(6): 455 - 468. [Abstract] [Full Text] [PDF]
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L. Hellgren, P. Kvidal, L.-G. Horte, U.-B. Krusemo, and E. Stahle Survival After Mitral Valve Replacement: Rationale for Surgery Before Occurrence of Severe Symptoms Ann. Thorac. Surg., October 1, 2004; 78(4): 1241 - 1247. [Abstract] [Full Text] [PDF]
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F. Langer, D. Aicher, A. Kissinger, O. Wendler, H. Lausberg, R. Fries, and H.-J. Schafers Aortic Valve Repair Using a Differentiated Surgical Strategy Circulation, September 14, 2004; 110(11_suppl_1): II-67 - II-73. [Abstract] [Full Text] [PDF]
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T. A. Timek, D. T. Lai, D. Liang, F. Tibayan, F. Langer, F. Rodriguez, G. T. Daughters, N. B. Ingels Jr, and D. C. Miller Effects of Paracommissural Septal-Lateral Annular Cinching on Acute Ischemic Mitral Regurgitation Circulation, September 14, 2004; 110(11_suppl_1): II-79 - II-84. [Abstract] [Full Text] [PDF]
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F. Rodriguez, F. Langer, K. B. Harrington, F. A. Tibayan, M. K. Zasio, A. Cheng, D. Liang, G. T. Daughters, J. W. Covell, J. C. Criscione, et al. Importance of Mitral Valve Second-Order Chordae for Left Ventricular Geometry, Wall Thickening Mechanics, and Global Systolic Function Circulation, September 14, 2004; 110(11_suppl_1): II-115 - II-122. [Abstract] [Full Text] [PDF]
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C. K. Haan, C. I. Cabral, D. A. Conetta, L. P. Coombs, and F. H. Edwards Selecting patients with mitral regurgitation and left ventricular dysfunction for isolated mitral valve surgery Ann. Thorac. Surg., September 1, 2004; 78(3): 820 - 825. [Abstract] [Full Text] [PDF]
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M. H. Yacoub and L. H. Cohn Novel Approaches to Cardiac Valve Repair: From Structure to Function: Part II Circulation, March 9, 2004; 109(9): 1064 - 1072. [Full Text] [PDF]
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O. Bech-Hanssen, T. Ryden, H. Schersten, A. Oden, F. Nilsson, and A. Jeppsson Mortality after mitral regurgitation surgery: importance of clinical and echocardiographic variables Eur. J. Cardiothorac. Surg., November 1, 2003; 24(5): 723 - 730. [Abstract] [Full Text] [PDF]
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P. S. Dahlberg, T. A. Orszulak, C. J. Mullany, R. C. Daly, M. Enriquez-Sarano, and H. V. Schaff Late outcome of mitral valve surgery for patients with coronary artery disease Ann. Thorac. Surg., November 1, 2003; 76(5): 1539 - 1548. [Abstract] [Full Text] [PDF]
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F. G. St. Goar, J. I. Fann, J. Komtebedde, E. Foster, M. C. Oz, T. J. Fogarty, T. Feldman, and P. C. Block Endovascular Edge-to-Edge Mitral Valve Repair: Short-Term Results in a Porcine Model Circulation, October 21, 2003; 108(16): 1990 - 1993. [Abstract] [Full Text] [PDF]
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M. F. Ibrahim, D. Paparella, J. Ivanov, M. R. Buchanan, and S. J. Brister Gender-related differences in morbidity and mortality during combined valve and coronary surgery J. Thorac. Cardiovasc. Surg., October 1, 2003; 126(4): 959 - 964. [Abstract] [Full Text] [PDF]
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R. R. Moss, K. H. Humphries, M. Gao, C. R. Thompson, J. G. Abel, G. Fradet, and B. I. Munt Outcome of Mitral Valve Repair or Replacement: A Comparison by Propensity Score Analysis Circulation, September 9, 2003; 108(90101): II-90 - 97. [Abstract] [Full Text] [PDF]
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C. M. Feindel, Z. Tufail, T. E. David, J. Ivanov, and S. Armstrong Mitral valve surgery in patients with extensive calcification of the mitral annulus J. Thorac. Cardiovasc. Surg., September 1, 2003; 126(3): 777 - 781. [Abstract] [Full Text] [PDF]
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T. Matsumura, E. Ohtaki, K. Tanaka, K. Misu, T. Tobaru, R. Asano, M. Nagayama, K. Kitahara, J. Umemura, T. Sumiyoshi, et al. Echocardiographic prediction ofleft ventricular dysfunction aftermitral valve repair for mitral regurgitation as anindicator to decide the optimal timing of repair J. Am. Coll. Cardiol., August 6, 2003; 42(3): 458 - 463. [Abstract] [Full Text] [PDF]
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V. H. Thourani, W. S. Weintraub, R. A. Guyton, E. L. Jones, W. H. Williams, S. Elkabbani, and J. M. Craver Outcomes and Long-Term Survival for Patients Undergoing Mitral Valve Repair Versus Replacement: Effect of Age and Concomitant Coronary Artery Bypass Grafting Circulation, July 22, 2003; 108(3): 298 - 304. [Abstract] [Full Text] [PDF]
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S. C. Reimold and J. D. Rutherford Valvular Heart Disease in Pregnancy N. Engl. J. Med., July 3, 2003; 349(1): 52 - 59. [Full Text] [PDF]
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A. M. Gillinov, C. Faber, P. L. Houghtaling, E. H. Blackstone, B.-K. Lam, R. Diaz, B. W. Lytle, J. F. Sabik III, and D. M. Cosgrove III Repair versus replacement for degenerative mitral valve disease with coexisting ischemic heart disease J. Thorac. Cardiovasc. Surg., June 1, 2003; 125(6): 1350 - 1362. [Abstract] [Full Text] [PDF]
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A. M. Gillinov, E. H. Blackstone, D. M. Cosgrove III, J. White, P. Kerr, A. Marullo, P. M. McCarthy, and B. W. Lytle Mitral valve repair with aortic valve replacement is superior to double valve replacement J. Thorac. Cardiovasc. Surg., June 1, 2003; 125(6): 1372 - 1387. [Abstract] [Full Text] [PDF]
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S. Bevilacqua, A. G. Cerillo, J. Gianetti, U. Paradossi, M. Mariani, S. Matteucci, E. Kallushi, and M. Glauber Mitral valve repair for degenerative disease: is pericardial posterior annuloplasty a durable option? Eur. J. Cardiothorac. Surg., April 1, 2003; 23(4): 552 - 559. [Abstract] [Full Text] [PDF]
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W. Flameng, P. Herijgers, and K. Bogaerts Recurrence of Mitral Valve Regurgitation After Mitral Valve Repair in Degenerative Valve Disease Circulation, April 1, 2003; 107(12): 1609 - 1613. [Abstract] [Full Text] [PDF]
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E. B. Savage, T. B. Ferguson Jr, and V. J. DiSesa Use of mitral valve repair: analysis of contemporary United States experience reported to the Society of Thoracic Surgeons National Cardiac Database Ann. Thorac. Surg., March 1, 2003; 75(3): 820 - 825. [Abstract] [Full Text] [PDF]
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C. M Otto Timing of surgery in mitral regurgitation Heart, January 1, 2003; 89(1): 100 - 105. [Full Text] [PDF]
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R. C. Gorman, J. H. Gorman III, and L. H. Edmunds Jr. Ischemic Mitral Regurgitation Card. Surg. Adult, January 1, 2003; 2(2003): 751 - 769. [Full Text]
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H. V. Schaff and D. H. Marsh Multiple Valve Disease Card. Surg. Adult, January 1, 2003; 2(2003): 1017 - 1045. [Full Text]
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