Key result
Mitral valve repair for severe ischemic mitral regurgitation had lower unadjusted hospital mortality than replacement (5% vs. 13%, p=0.01), but was not an independent predictor after adjustment.
Why the study?
The benefit of mitral valve repair over replacement in patients with severe ischemic mitral regurgitation remains controversial.
Does mitral valve repair reduce hospital mortality compared to mitral valve replacement in patients with severe ischemic mitral regurgitation?
Cohort (n=393)
No
Does mitral valve repair reduce hospital mortality compared to mitral valve replacement in patients with severe ischemic mitral regurgitation?
Absolute Event Rate: 5% vs 13%
p-value: p=0.01
In patients with severe ischemic mitral regurgitation, mitral valve repair does not confer an independent early survival benefit over replacement after adjusting for baseline clinical severity.
No independent mortality benefit of repair after adjustment; leaves open optimal strategy pending randomized data in ischemic mitral regurgitation.
BACKGROUND: The benefit of mitral valve repair (MVr) over replacement in patients with severe ischemic mitral regurgitation (IMR) is still controversial. We report our early postoperative outcomes of repair versus replacement. METHODS: Data were collected for patients undergoing first-time mitral valve surgery for severe IMR between 1990 and 2009 (n = 393). Patients who underwent combined procedures for papillary muscle rupture, post-infarction ventricular septal defect, endocarditis, or any previous cardiac surgery were excluded. Preoperative demographics, operative variables, and hospital outcomes were analyzed, and multivariable regression analysis was employed to identify independent predictors of hospital mortality. RESULTS: Valve repair was performed in 42% (n = 164) of patients and replacement in 58% (n = 229). Patients who underwent replacement were older and had a higher prevalence of unstable angina, New York Heart Association Class IV symptoms, preoperative cardiogenic shock, preoperative myocardial infarction, peripheral vascular disease, renal failure, and urgent or emergency surgery (all p < .05). Unadjusted hospital mortality was higher in patients undergoing valve replacement (13% vs. 5%; p = .01). Valve repair was associated with a lower prevalence of postoperative low cardiac output syndrome. Multivariable analysis revealed that age, urgency of operation, and preoperative left ventricular (LV) function were independent predictors of hospital mortality. Importantly, MVr versus replacement was not an independent predictor of hospital mortality. CONCLUSION: Our data did not suggest an early survival benefit to MVr over replacement for IMR. However, age, LV dysfunction, and the need for urgent surgery were independently associated with hospital mortality.
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Elhenawy et al. (2020) conducted a cohort in Severe ischemic mitral regurgitation (n=393). Mitral valve repair vs. Mitral valve replacement was evaluated on Hospital mortality (p=0.01). Mitral valve repair for severe ischemic mitral regurgitation had lower unadjusted hospital mortality than replacement (5% vs. 13%, p=0.01), but was not an independent predictor after adjustment.
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