910-16 Ventricular Size and Function Early and Late After Mitral Valve Repair vs Mitral Valve Replacement for Mitral Regurgitation

This study compares mitral valve repair and mitral valve replacement with chordal preservation for chronic mitral regurgitation due to myxomatous degeneration with special reference to left ventricular function. Twenty-six patients underwent complete preoperative and 2 years later postoperative echocardiography study. Thirteen patients underwent mitral valve replacement associated with preservation of chordae tendineae and papillary muscles, and 13 patients had mitral valve repair. There were no statistically significant differences between the 2 groups for clinical findings, hemodynamic profiles, or left ventricular function compared prior to surgery. After correcting mitral regurgitation, increase in cardiac index was significant for the repair group. Left ventricular end-diastolic volume decreased in both groups. Left ventricular end-systolic volume significantly decreased in the repair group, but remained unchanged in the replacement group. Both ejection fraction and mean left ventricular circumferential fiber shortening velocity (mVcf) decreased in the replacement group, but significantly increased in the repair group 2 years after surgery. These findings suggest valve replacement with chordal preservation shows less improvement in ventricular systolic function late after surgery compared with mitral valve repair.

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Meta-analysis of two different surgical treatments of ischaemic mitral regurgitation with the same outcome: mitral valve repair vs mitral valve replacement

Acta Cardiologica ◽

10.1080/ac.71.5.3167501 ◽

2016 ◽

Vol 71 (5) ◽

pp. 573-580

Author(s):

Hua Zhang ◽

Yili Liu ◽

Jianping Bin ◽

Shaodong Qiu ◽

Fei Chen

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Mitral Valve Repair ◽

Meta Analysis ◽

Valve Repair ◽

Surgical Treatments

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Abstract 2286: Short- and Long-Term Survival of Mitral Valve Repair Versus Mitral Valve Replacement in Patients with Functional Mitral Regurgitation

Circulation ◽

10.1161/circ.118.suppl_18.s_698-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Julien Magne ◽

Mario Senechal ◽

Patrick Mathieu ◽

François Dagenais ◽

Jean G Dumesnil ◽

...

Keyword(s):

Surgical Treatment ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Mitral Valve Repair ◽

Valve Repair ◽

Term Survival ◽

Long Term Mortality

Mitral valve repair (MVRp) is associated with better survival in patients with organic mitral regurgitation (MR) when compared to mitral valve replacement (MVR). However, there is an important controversy about the type of surgical treatment that should be used in patients with functional MR (FMR). The aim of this study was to compare MVRp (i.e. restrictive annuloplasty) and MVR in patients with FMR. Pre- and operative demographic and clinical data of 392 patients (64% of male, mean age: 65±10 years) with FMR who underwent mitral surgery between 1992 and 2007 were prospectively collected in a computerized database. MVRp was performed in 52% of patients (n=204) and MVR in 48% (n=188). Compared to patients undergoing MVRp, those with MVR were significantly more frequently symptomatic (77% vs. 59%, p=0.0002), had lower left ventricular ejection fraction (LVEF) (40±15%, vs. 46±15%, p=0.0003) and had higher prevalence of pulmonary hypertension (36% vs. 24%, p=0.01) preoperatively. However, there was no significant difference between the 2 groups with regards to age, gender, MR severity, diabetes, obesity, systemic hypertension and atrial fibrillation (p>0.3). Although operative mortality was significantly lower after MVRp compared to MVR (9% vs. 17%, p=0.02), long-term survival was not statistically different between procedures (6 years: 74±4% vs. 72±4%; 12 years: 54±5% vs. 52±7%; p=0.58). After adjusting for other risk factors, the type of procedure (MVRp vs. MVR) did not come out as an independent predictor of either operative (Odds-ratio=1.7, 95% confidence interval [CI]: 0.8 –3.8, p=0.15) or long-term mortality (Hazard-ratio [HR]=1.1, 95%CI: 0.9 –1.4, p=0.29). The independent predictors of long-term mortality were age (HR= 1.04, 95%CI: 1.01–1.07, p=0.003), NYHA class ≥III (HR=1.4, 95%CI: 1.1–2, p=0.02) and LVEF (HR=1.02, 95%CI: 1.01–1.04, p=0.0009). As opposed to what has been reported in patients with organic MR, there is no evidence that MVRp provides any benefit in terms of survival compared to MVR in patients with FMR. These findings suggest that MVRp is not an optimal surgical treatment for FMR and provide an impetus toward the development of new surgical approaches for these patients.

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