Key result
Surgical edge-to-edge approximation with mild-undersizing annuloplasty offered similar durability to replacement and may confer a survival advantage (P=0.002).
Why the study?
Evidence supports replacement over repair for ischemic mitral regurgitation due to improved durability, but repair often involves undersized ring annuloplasty without edge-to-edge approximation.
Does edge-to-edge leaflet approximation with mild-undersized annuloplasty improve survival and reduce heart failure hospitalization compared to mitral valve replacement or undersized restrictive annuloplasty in patients with moderate-severe or greater ischemic mitral regurgitation?
Cohort
No
Does edge-to-edge leaflet approximation with mild-undersized annuloplasty improve survival and reduce heart failure hospitalization compared to mitral valve replacement or undersized restrictive annuloplasty in patients with moderate-severe or greater ischemic mitral regurgitation?
Surgical edge-to-edge approximation with mild-undersizing annuloplasty may offer similar durability, lower heart failure hospitalization, and a survival advantage compared to replacement for ischemic mitral regurgitation.
Answers are grounded in this paper and cite their sources.
May favor edge-to-edge repair with annuloplasty over replacement; leaves open randomized confirmation of survival benefit.
Objective: Evidence supports replacement over repair for ischemic mitral regurgitation due to improved durability; however, the latter often involves an undersized ring annuloplasty that does not include edge-to-edge approximation. The objective of this study was to evaluate the outcomes of replacement, edge-to-edge leaflet approximation with mild-undersized annuloplasty and undersized ring annuloplasty for ischemic mitral regurgitation. Methods: This is a single-center retrospective study of patients undergoing mitral surgery for moderate-severe or greater ischemic mitral regurgitation, between 2004 and 2020, with mild-undersized annuloplasty, mitral valve replacement, or undersized restrictive annuloplasty (undersized ring annuloplasty). The primary outcome was all-cause mortality. Secondary outcomes included first recurrence of mitral regurgitation, heart failure hospitalization, and composite of valve-related events (bleeding, thromboembolism, endocarditis, and mitral valve reoperation). Conclusions: Surgical edge-to-edge approximation in addition to a mild-undersizing annuloplasty offers similar durability compared with replacement, with a lower rate of hospitalization for heart failure, and may confer a survival advantage.
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Nantsios et al. (2023) conducted a cohort in Ischemic mitral regurgitation. Edge-to-edge leaflet approximation with mild-undersized annuloplasty vs. Mitral valve replacement or undersized restrictive annuloplasty was evaluated on All-cause mortality (p== .002). Surgical edge-to-edge approximation with mild-undersizing annuloplasty offered similar durability to replacement and may confer a survival advantage (P=0.002).
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