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Published on: December 11, 2017
Is repair preferable to replacement for ischemic mitral regurgitation?
A M Gillinov1, P N Wierup, E H Blackstone
1Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. gillinom@ccf.org
The Journal of Thoracic and Cardiovascular Surgery
|December 1, 2001
Summary
Mitral valve repair offers better survival than replacement for most ischemic mitral regurgitation patients. However, in high-risk cases, survival rates for both procedures are similar.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Disease
- Interventional Cardiology
Background:
- Ischemic mitral regurgitation (IMR) poses significant challenges in cardiac surgery.
- Comparing surgical interventions for IMR is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare the effectiveness of mitral valve repair versus replacement in patients with ischemic mitral regurgitation.
- To identify predictors of survival and benefit from repair in IMR.
Main Methods:
- A cohort of 482 patients with IMR underwent either valve repair or replacement between 1985 and 1997.
- Multivariable propensity matching was employed to adjust for baseline differences.
- Risk factors for mortality were analyzed using multivariable, multiphase hazard function analysis.
Main Results:
- In a propensity-matched better-risk group, mitral valve repair demonstrated superior survival rates compared to replacement at 5 years (58% vs. 36%).
- In a poor-risk group, survival rates after repair and replacement were similar.
- Approximately 70% of patients were predicted to benefit from repair, with outcomes influenced by graft use and specific echocardiographic findings.
Conclusions:
- Late survival after surgery for IMR remains suboptimal.
- Mitral valve repair is beneficial for the majority of IMR patients.
- In high-risk IMR patients, mitral valve repair and replacement offer comparable survival outcomes.
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