Irving L Kron1, Judy Hung2, Jessica R Overbey3, Denis Bouchard4, Annetine C Gelijns5, Alan J Moskowitz3, Pierre Voisine6, Patrick T O'Gara7, Michael Argenziano8, Robert E Michler9, Marc Gillinov10, John D Puskas11, James S Gammie12, Michael J Mack13, Peter K Smith14, Chittoor Sai-Sudhakar15, Timothy J Gardner16, Gorav Ailawadi1, Xin Zeng2, Karen O'Sullivan3, Michael K Parides3, Roger Swayze9, Vinod Thourani11, Eric A Rose3, Louis P Perrault4, Michael A Acker17. 1. Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Va. 2. Division of Cardiology, Massachusetts General Hospital, Boston, Mass. 3. International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY. 4. Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada. 5. International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: Annetine.gelijns@mountsinai.edu. 6. Institut Universitaire de Cardiologie de Quebec, Hopital Laval, Quebec, Canada. 7. Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass. 8. Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY. 9. Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY. 10. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio. 11. Department of Cardiac Surgery, Mount Sinai Beth Israel, Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY. 12. Division of Cardiac Surgery, University of Maryland, Baltimore, Md. 13. Cardiothoracic Surgery, Baylor Research Institute, Baylor Scott & White Health, Plano, Tex. 14. Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, NC. 15. Cardiac Surgery, The Ohio State University Medical Center, Columbus, Ohio. 16. Center for Heart & Vascular Health, Christiana Care Health System, Newark, Del. 17. Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
Abstract
OBJECTIVES: The Cardiothoracic Surgical Trials Network recently reported no difference in the primary end point of left ventricular end-systolic volume index at 1 year postsurgery in patients randomized to repair (n = 126) or replacement (n = 125) for severe ischemic mitral regurgitation. However, patients undergoing repair experienced significantly more recurrent mitral regurgitation than patients undergoing replacement (32.6% vs 2.3%). We examined whether baseline echocardiographic and clinical characteristics could identify those who will develop moderate/severe recurrent mitral regurgitation or die. METHODS: Our analysis includes 116 patients who were randomized to and receivedmitral valve repair. Logistic regression was used to estimate a model-based probability of recurrence or death from baseline factors. Receiver operating characteristic curves were constructed from these estimated probabilities to determine classification cut-points maximizing accuracy of prediction based on sensitivity and specificity. RESULTS: Of the 116 patients, 6 received a replacement before leaving the operating room; all other patients had mild or less mitral regurgitation on intraoperative echocardiogram after repair. During the 2-year follow-up period, 76 patients developed moderate/severe mitral regurgitation or died (53 mitral regurgitation recurrences, 13 mitral regurgitation recurrences and death, and 10 deaths). The mechanism for recurrent mitral regurgitation was largely mitral valve leaflet tethering. Our model (including age, body mass index, sex, race, effective regurgitant orifice area, basal aneurysm/dyskinesis, New York Heart Association class, history of coronary artery bypass grafting, percutaneous coronary intervention, or ventricular arrhythmias) yielded an area under the receiver operating characteristic curve of 0.82. CONCLUSIONS: The model demonstrated good discrimination in identifying patients who will survive 2 years without recurrent mitral regurgitation after mitral valve repair. Although our results require validation, they offer a clinically relevant risk score for selection of surgical candidates for this procedure.
RCT Entities:
OBJECTIVES: The Cardiothoracic Surgical Trials Network recently reported no difference in the primary end point of left ventricular end-systolic volume index at 1 year postsurgery in patients randomized to repair (n = 126) or replacement (n = 125) for severe ischemic mitral regurgitation. However, patients undergoing repair experienced significantly more recurrent mitral regurgitation than patients undergoing replacement (32.6% vs 2.3%). We examined whether baseline echocardiographic and clinical characteristics could identify those who will develop moderate/severe recurrent mitral regurgitation or die. METHODS: Our analysis includes 116 patients who were randomized to and received mitral valve repair. Logistic regression was used to estimate a model-based probability of recurrence or death from baseline factors. Receiver operating characteristic curves were constructed from these estimated probabilities to determine classification cut-points maximizing accuracy of prediction based on sensitivity and specificity. RESULTS: Of the 116 patients, 6 received a replacement before leaving the operating room; all other patients had mild or less mitral regurgitation on intraoperative echocardiogram after repair. During the 2-year follow-up period, 76 patients developed moderate/severe mitral regurgitation or died (53 mitral regurgitation recurrences, 13 mitral regurgitation recurrences and death, and 10 deaths). The mechanism for recurrent mitral regurgitation was largely mitral valve leaflet tethering. Our model (including age, body mass index, sex, race, effective regurgitant orifice area, basal aneurysm/dyskinesis, New York Heart Association class, history of coronary artery bypass grafting, percutaneous coronary intervention, or ventricular arrhythmias) yielded an area under the receiver operating characteristic curve of 0.82. CONCLUSIONS: The model demonstrated good discrimination in identifying patients who will survive 2 years without recurrent mitral regurgitation after mitral valve repair. Although our results require validation, they offer a clinically relevant risk score for selection of surgical candidates for this procedure.
Authors: Martin Troubil; Pavel Marcian; Marek Gwozdziewicz; Petr Santavy; Katerina Langova; Petr Nemec; Vladimir Lonsky Journal: J Card Surg Date: 2011-11-11 Impact factor: 1.620
Authors: Agnieszka Ciarka; Jerry Braun; Victoria Delgado; Michel Versteegh; Eric Boersma; Robert Klautz; Robert Dion; Jeroen J Bax; Nico Van de Veire Journal: Am J Cardiol Date: 2010-08-01 Impact factor: 2.778
Authors: Louis P Perrault; Alan J Moskowitz; Irving L Kron; Michael A Acker; Marissa A Miller; Keith A Horvath; Vinod H Thourani; Michael Argenziano; David A D'Alessandro; Eugene H Blackstone; Claudia S Moy; Joseph P Mathew; Judy Hung; Timothy J Gardner; Michael K Parides Journal: J Thorac Cardiovasc Surg Date: 2011-11-04 Impact factor: 5.209
Authors: A M Gillinov; P N Wierup; E H Blackstone; E S Bishay; D M Cosgrove; J White; B W Lytle; P M McCarthy Journal: J Thorac Cardiovasc Surg Date: 2001-12 Impact factor: 5.209
Authors: Wobbe Bouma; Iwan C C van der Horst; Inez J Wijdh-den Hamer; Michiel E Erasmus; Felix Zijlstra; Massimo A Mariani; Tjark Ebels Journal: Eur J Cardiothorac Surg Date: 2009-08-27 Impact factor: 4.191
Authors: Philipp E Bartko; Jacob P Dal-Bianco; J Luis Guerrero; Jonathan Beaudoin; Catherine Szymanski; Dae-Hee Kim; Margo M Seybolt; Mark D Handschumacher; Suzanne Sullivan; Michael L Garcia; James S Titus; Jill Wylie-Sears; Whitney S Irvin; Emmanuel Messas; Albert A Hagège; Alain Carpentier; Elena Aikawa; Joyce Bischoff; Robert A Levine Journal: J Am Coll Cardiol Date: 2017-09-05 Impact factor: 24.094