OBJECTIVES: We aimed to assess the influence of type of operation on outcome in degenerative mitral regurgitation. METHODS: We compared outcomes in 278 consecutive patients who underwent mitral valve repair (167 patients), replacement with subvalvular preservation (22 patients) and without subvalvular preservation (89 patients) for degenerative mitral regurgitation. RESULTS: There was a trend towards lower mortality with repair and replacement with subvalvular preservation compared to replacement without subvalvular preservation. Thirty-day mortality was 1.2% vs 0.0% vs 4.7% (ns) respectively. Six-year survival was, respectively, 67.8 +/- 7.4% (P = 0.088) vs 80.8 +/- 11.0% (P = 0.25) vs 63.3 +/- 5.9% for all-cause death, 78.5 +/- 6.8% (P = 0.063) vs 95.5 +/- 4.4% (P = 0.092) vs 67.6 +/- 5.9% for all complication-related death and 80.5 +/- 6.9% (P = 0.076) vs 100.0 +/- 0.0% (P = 0.045) vs 72.8 +/- 5.8% for complication-related death due to myocardial failure. Multivariate analysis confirmed independent beneficial effects from repair compared to replacement without subvalvular preservation on complication-related death (hazard ratio 0.42, P = 0.010) and death from myocardial failure (hazard ratio 0.40, P = 0.014), and from repair compared to mechanical replacement on thromboembolism (hazard ratio 0.45, P = 0.029) and anticoagulation-related haemorrhage (hazard ratio 0.19, P = 0.026). CONCLUSIONS: Mitral valve repair is superior to replacement. The greatest survival advantage is in reduced mortality from myocardial failure. Repair should be the operation of choice for degenerative mitral regurgitation.
OBJECTIVES: We aimed to assess the influence of type of operation on outcome in degenerative mitral regurgitation. METHODS: We compared outcomes in 278 consecutive patients who underwent mitral valve repair (167 patients), replacement with subvalvular preservation (22 patients) and without subvalvular preservation (89 patients) for degenerative mitral regurgitation. RESULTS: There was a trend towards lower mortality with repair and replacement with subvalvular preservation compared to replacement without subvalvular preservation. Thirty-day mortality was 1.2% vs 0.0% vs 4.7% (ns) respectively. Six-year survival was, respectively, 67.8 +/- 7.4% (P = 0.088) vs 80.8 +/- 11.0% (P = 0.25) vs 63.3 +/- 5.9% for all-cause death, 78.5 +/- 6.8% (P = 0.063) vs 95.5 +/- 4.4% (P = 0.092) vs 67.6 +/- 5.9% for all complication-related death and 80.5 +/- 6.9% (P = 0.076) vs 100.0 +/- 0.0% (P = 0.045) vs 72.8 +/- 5.8% for complication-related death due to myocardial failure. Multivariate analysis confirmed independent beneficial effects from repair compared to replacement without subvalvular preservation on complication-related death (hazard ratio 0.42, P = 0.010) and death from myocardial failure (hazard ratio 0.40, P = 0.014), and from repair compared to mechanical replacement on thromboembolism (hazard ratio 0.45, P = 0.029) and anticoagulation-related haemorrhage (hazard ratio 0.19, P = 0.026). CONCLUSIONS:Mitral valve repair is superior to replacement. The greatest survival advantage is in reduced mortality from myocardial failure. Repair should be the operation of choice for degenerative mitral regurgitation.
Authors: B Bridgewater; T Hooper; C Munsch; S Hunter; U von Oppell; S Livesey; B Keogh; F Wells; M Patrick; J Kneeshaw; J Chambers; N Masani; S Ray Journal: Heart Date: 2005-10-26 Impact factor: 5.994
Authors: A Stork; O Franzen; H Ruschewski; C Detter; K Müllerleile; P M Bansmann; G Adam; G K Lund Journal: Eur Radiol Date: 2007-06-05 Impact factor: 5.315
Authors: Oladipupo Olafiranye; Clare A Hochreiter; Jeffrey S Borer; Phyllis G Supino; Edmund M Herrold; Adam S Budzikowski; Ofek Y Hai; Dany Bouraad; Paul D Kligfield; Leonard N Girardi; Karl H Krieger; O Wayne Isom Journal: Cardiology Date: 2013-02-20 Impact factor: 1.869