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Mitral repair versus replacement for ischemic mitral regurgitation
Osman O Al-Radi1, Peter C Austin, Jack V Tu
1Division of Cardiovascular Surgery, Toronto General Hospital, and the Department of Surgery, University of Toronto, Toronto, Ontario, Canada. terry.yau@utoronto.ca
The Annals of Thoracic Surgery
|March 31, 2005
Summary
Mitral valve repair offers better early survival for papillary muscle infarction (PM-IMR) but not for left ventricular dysfunction (LV-IMR). Long-term benefits of repair were not evident for either condition.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Mitral Valve Disease
Background:
- Chronic ischemic mitral regurgitation (IMR) presents challenges in treatment selection.
- Distinguishing between IMR due to left ventricular dysfunction (LV-IMR) and papillary muscle infarction (PM-IMR) is crucial for therapeutic strategy.
Purpose of the Study:
- To compare the long-term efficacy of mitral valve repair versus replacement in patients with chronic ischemic mitral regurgitation.
- To evaluate outcomes based on the specific etiology of IMR: LV-IMR and PM-IMR.
Main Methods:
- A cohort of 65 patients undergoing mitral repair and 137 undergoing replacement (1990-2001) was analyzed.
- Cox survival analysis with propensity score adjustment and bootstrap validation was employed.
- Patients were stratified into LV-IMR (n=87) and PM-IMR (n=115) groups, excluding those in cardiogenic shock.
Main Results:
- Mitral repair demonstrated superior early survival in the PM-IMR group (adjusted HR 0.25 at 1 year).
- No significant survival advantage for repair was observed in the LV-IMR group or in high-acuity PM-IMR patients.
- Reoperation rates were higher after repair (14%) compared to replacement (3%).
Conclusions:
- Mitral valve repair provides significant early survival benefits for PM-IMR patients, diminishing over time.
- Repair does not offer a clear survival advantage for LV-IMR patients.
- The choice between mitral repair and replacement should consider the specific IMR etiology and patient acuity.