What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic ischemic mitral regurgitation with left ventricular dysfunction (n=218). Intervention: Mitral valve repair vs. Mitral valve replacement. Primary outcome: 5-year survival (p=>0.05).

November 8, 2010Journal of Cardiothoracic SurgeryOpen Access

Is mitral valve repair superior to replacement for chronic ischemic mitral regurgitation with left ventricular dysfunction?

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Key result

Mitral valve repair and mitral valve replacement resulted in similar 5-year survival rates (73% vs. 71%, P>0.05) in patients with chronic ischemic mitral regurgitation and left ventricular dysfunction, though replacement provided better long-term correction of mitral regurgitation.

Why the study?

Does mitral valve repair improve survival and left ventricular remodeling compared to mitral valve replacement in patients with chronic ischemic mitral regurgitation and left ventricular dysfunction?

Population

218 consecutive patients with chronic ischemic mitral regurgitation and left ventricular dysfunction…

Comparison

Mitral valve repair with ring annuloplasty… vs Mitral valve replacement combined with CABG…

Design

Cohort

Follow-up

Mean 48.1 ± 13.7 months for MVP and 50.2 ± 14.4 months for…

Authors

ZQZhibing QiuHuashan Hospital XCXin ChenGeorgia Institute of Technology MXMing XuNanjing Agricultural University

Discussion

Member takes

Implication

Survival equivalent after repair or replacement in ischemic MR with LV dysfunction; leaves open optimal strategy pending randomized trials.

Study Design

Type

Cohort (n=218)

Multicenter

Structured PICO

Does mitral valve repair improve survival and left ventricular remodeling compared to mitral valve replacement in patients with chronic ischemic mitral regurgitation and left ventricular dysfunction?

Population

218 patients with severe chronic ischemic mitral regurgitation and left ventricular dysfunction who underwent concomitant coronary artery bypass grafting and mitral valve surgery, followed for a mean of 49 months.

Exposure

Mitral valve repair (MVP) with ring annuloplasty (median size 30 mm) combined with CABG.

Comparator

Mitral valve replacement (MVR) (62.3% bioprosthesis, 37.7% mechanical) combined with CABG, with preservation of the subvalvular apparatus in the majority of cases.

Outcome

Early and midterm survival, New York Heart Association (NYHA) functional class, echocardiographic modifications of left ventricle, and the presence of any grade of IMR.hard clinical

Main Result

Absolute Event Rate: 73% vs 71%

p-value: p=>0.05

In patients with severe ischemic mitral regurgitation and left ventricular dysfunction, mitral valve replacement may offer better long-term left ventricular reverse remodeling and lower MR recurrence than repair, despite similar long-term survival.

Limitations

Single-institution retrospective review, which may introduce selection bias for valves that are able to be repaired.
Difficulty in assessing the complexity of valve disease and degree of annular calcification from operative notes.
Patients with intermittent ischemic mitral regurgitation treated by coronary revascularization alone were not included.
Retrospective design
Non-randomized (selection bias in procedure choice)
Single-center study

Cite This Study

Qiu et al. (2010) conducted a cohort in Chronic ischemic mitral regurgitation with left ventricular dysfunction (n=218). Mitral valve repair vs. Mitral valve replacement was evaluated on 5-year survival (p=>0.05). Mitral valve repair and mitral valve replacement resulted in similar 5-year survival rates (73% vs. 71%, P>0.05) in patients with chronic ischemic mitral regurgitation and left ventricular dysfunction, though replacement provided better long-term correction of mitral regurgitation.

synapsesocial.com/papers/6a96f3b033d7b00ae7bba944 https://doi.org/10.1186/1749-8090-5-107

Topics

Mitral valve intervention Echocardiography

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Implication

Survival equivalent after repair or replacement in ischemic MR with LV dysfunction; leaves open optimal strategy pending randomized trials.

Is mitral valve repair superior to replacement for chronic ischemic mitral regurgitation with left ventricular dysfunction?

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Is mitral valve repair superior to replacement for chronic ischemic mitral regurgitation with left ventricular dysfunction?

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider