Impact Of Mitral Valve Repair Research Articles

Kiosk 6R-TA-01 - Impact of Mitral Valve Repair on Left Atrial Fibrosis in Patients with Severe Mitral Valve Regurgitation: Insights FBom the ALIVE Trial

Kiosk 6R-TA-01 - Impact of Mitral Valve Repair on Left Atrial Fibrosis in Patients with Severe Mitral Valve Regurgitation: Insights FBom the ALIVE Trial

Concomitant Mitral Valve Surgery Versus No Intervention in Patients with Moderate Ischemic Mitral Regurgitation Undergoing Coronary Artery Bypass Grafting: A Propensity Score Analysis

Objectives Ischemic mitral valve regurgitation (IMR) in patients undergoing coronary artery bypass grafting (CABG) is associated with worse long-term outcomes. This study aimed to assess the impact of mitral valve repair with CABG in patients with moderate IMR.Materials This observational study enrolled 3,215 consecutive patients from the Juntendo CABG registry with moderate IMR and multivessel coronary artery disease who underwent CABG between 2002 and 2017.Methods The CABG alone and CABG with mitral valve surgery (MVs) groups were compared. The propensity score was calculated for each patient. Long-term all-cause death, cardiac death, and major adverse cardiac and cerebrovascular events (MACCEs) were compared.Results Our database had 101 patients who underwent CABG with moderate IMR. Propensity score matching selected 40 pairs for final analysis. MVs was associated with increased risks of postoperative atrial fibrillation, blood transfusion, and longer hospitalization. Long-term outcomes, including all-cause mortality, cardiac mortality, and the incidence of MACCEs were similar.Conclusion Surgical treatment of moderate IMR combined with CABG was related to increased risk of several non-fatal short-term complications when compared to CABG alone, with similar long-term outcomes. Further studies are needed to determine the effects of MVs in patients with moderate IMR and severe coronary artery disease.

Differential Impact of Mitral Valve Repair on Outcome of Coronary Artery Bypass Grafting with or without Surgical Ventricular Reconstruction in the Surgical Treatment for Ischemic Heart Failure (STICH) Trial

ABSTRACT Background: This study examined the impact of mitral valve repair (MVRe) on survival of patients with moderate or severe (≥2+) MR and ischemic cardiomyopathy randomized to coronary artery bypass grafting (CABG) versus CABG+surgical ventricular reconstruction (SVR) in the STICH trial. Methods: Among patients with moderate or severe MR and ischemic cardiomyopathy undergoing CABG or CABG+SVR, the impact of MVRe on mortality between the two treatment arms was compared. Results: Among 867 patients with assessment of baseline MR severity, 211 had moderate or severe MR. After excluding 7 patients who underwent mitral valve replacement, 50, 44, 62, and 48 patients underwent CABG, CABG+MVRe, CABG+SVR, and CABG+SVR+MVRe, respectively. Four-year mortality rates were lower following CABG+MVRe than CABG alone (16% vs. 55%; adjusted hazard ratio [HR] 0.30; 95% CI 0.13–0.71). In contrast, the CABG+SVR+MVRe and CABG+SVR groups had similar 4-year mortality of 39% vs. 39% (adjusted HR 0.88; 95% CI 0.46–1.70). MVRe had a more favorable effect on survival in patients undergoing CABG alone compared to CABG+SVR (p = 0.013). Baseline MR severity was similar between patients that received CABG+MVRe and those that underwent CABG+SVR+MVRe. A larger proportion of patients demonstrated a reduction in MR between 4 and 24 months after CABG+MVRe compared to CABG+SVR+MVRe (50.0% versus 25.0%, p = 0.023). Conclusion: In patients with moderate or severe MR and ischemic cardiomyopathy undergoing CABG, MVRe appears to have a favorable effect on survival. The addition of SVR to CABG may attenuate the anticipated benefits of MVRe by limiting the long-term reduction of MR with MVRe.

Concomitant aortic and mitral surgery: To replace or repair the mitral valve?

The study objectives were to evaluate the perioperative outcomes of concomitant mitral and aortic valve surgery and to determine the influence of mitral valve repair versus replacement on survival and adverse events. The study population comprised 261 patients with a mean age of 61.3±11.2 (19-82) years; 57.5% were male, and 73% were in New York Heart Association class III or IV. Mitral valve repair was performed in 209 patients (80%), and mitral valve replacement was performed in 52 patients (20%). Follow-up was complete for 95% of the patients (1395 patient-years). We specifically examined the impact of mitral valve repair versus replacement by comparing 2 propensity-matched subgroups. Degenerative and functional mitral regurgitation, and left ventricular dilation and dysfunction were associated with mitral valve repair (P<.05). Rheumatic disease, chronic obstructive pulmonary disease, redo surgery, mitral calcification, and atrial fibrillation were more frequently related to mitral valve replacement (P<.05). Overall 30-day mortality was 1.1% (3 patients). Overall 1-, 5-, and 8-year survival were 98.0%±2.0%, 85.9%±6.1%, and 79.8%±8.2%, respectively, for the mitral valve replacement group and 95.3%±1.5%, 87.4%±2.6%, and 75.2%±4.0%, respectively, for the mitral valve repair group (P=.906). This was confirmed by comparable survival in propensity-matched analyses. Mitral valve repair showed a survival advantage in older patients (aged ≥65 years) and patients with nonrheumatic mitral valves (P=.017 and P=.034, respectively). Bleeding events (83% vs 60%), endocarditis (97.6% vs 84.6%), and reoperation (97.6% vs 86.9%) were higher in those undergoing mitral valve replacement. Freedom from major adverse valve-related events was higher for the mitral valve repair group (P=.002). Mitral valve replacement was identified as an independent risk factor for major adverse valve-related events (hazard ratio, 1.99; P=.018). Concomitant mitral and aortic valve surgery carries a low surgical risk. The choice of the mitral procedure did not significantly affect survival. However, mitral valve replacement was associated with an increased incidence of adverse events. Thus, valve repair, whenever feasible, is a better option.

Impact of mitral valve repair on late postoperative left ventricular function in patients with non-ischemic cardiomyopathy

Impact of mitral valve repair on late postoperative left ventricular function in patients with non-ischemic cardiomyopathy

TCT-784 Prognostic Implications of Moderate and Severe Mitral Regurgitation in Contemporary Clinical Care

The impact of mitral valve repair in patients with severe mitral regurgitation (MR), particularly with significant LV dysfunction and comorbidities is difficult to predict. We examined the possible long-term prognostic impact of MR. This was a match case-control study that recruited 532 patients

Impact of Mitral Valve Repair in Patients with End-Stage Congestive Heart Failure

Objective: The utility of mitral valve repair in patients with Mitral Regurgitation (MR) and advanced CHF remains controversial. Methods: 37 patients with MR and Left Ventricular Ejection Fraction (LVEF) 25% as well as patients with LVIDd Results: Operative mortality was 0% for the group. There were significant reductions in NYHA Class (p = 0.0004), mitral regurgitation (p 25%. There were no significant differences in cardiac outcome changes between patients with LVIDd 25%, and between patients with LVIDd Conclusions: MV repair in patients with low LVEF and MR can be performed safely, with significant improvement in LVEF and symptom profile. No survival difference were noted between those patients with severely depressed LVEF or those with elevated ventricular dimensions (LVIDd) when compared to those with less severe but still significant cardiac impairment. Consideration should be given to these patients as an option prior to transplantation.

Mitral regurgitation surgery in patients with ischemic cardiomyopathy and ischemic mitral regurgitation: Factors that influence survival

The treatment of patients with ischemic cardiomyopathy and concomitant mitral regurgitation can be challenging and is associated with reduced long-term survival. It is unclear how mitral valve repair versus replacement affects subsequent outcome. Therefore, we conducted this study to understand the predictors of mortality and to delineate the role of mitral valve repair versus replacement in this high-risk population. From 1993 to 2007, 431 patients (mean age, 70 ± 9 years) with ischemic cardiomyopathy (left ventricular ejection fraction ≤ 45%) and significant ischemic mitral regurgitation (>2) were identified. Patients (44) with concomitant mitral stenosis were excluded from the analysis. A homogeneous group of 387 patients underwent combined coronary artery bypass grafting and mitral valve surgery, mitral valve repair in 302 (78%) and mitral valve replacement in 85 (22%). Uni- and multivariate analyses were performed on the entire cohort, and the predictors of mortality were identified in 2 distinct risk phases. Furthermore, we specifically examined the impact of mitral valve repair versus replacement by comparing 2 propensity-matched subgroups. Follow-up was 100% complete (median, 3.6 years; range, 0-15 years). Overall 1-, 5-, and 10-year survivals were 82.7%, 55.2%, and 24.3%, respectively, for the entire group. The risk factors for an increased mortality within the first year of surgery included previous coronary artery bypass grafting (hazard ratio = 3.39; P < .001), emergency/urgent status (hazard ratio = 2.08; P = .007), age (hazard ratio = 1.5; P = .03), and low left ventricular ejection fraction (hazard ratio = 1.31; P = .026). Thereafter, only age (hazard ratio = 1.58; P < .001), diabetes (hazard ratio = 2.5; P = .001), and preoperative renal insufficiency (hazard ratio = 1.72; P = .025) were predictive. The status of mitral valve repair versus replacement did not influence survival, and this was confirmed by comparable survival in propensity-matched analyses. Survival after combined coronary artery bypass grafting and mitral valve surgery in patients with ischemic cardiomyopathy (left ventricular ejection fraction ≤ 45%) and mitral regurgitation is compromised and mostly influenced by factors related to the patient's condition at the time of surgery. The specifics of mitral valve repair versus replacement did not seem to affect survival.

Impact of mitral valve repair in patients with mitral regurgitation undergoing coronary artery bypass grafting.

The benefit of concomitant mitral valve correction (replacement or reconstruction, MVR) and coronary artery bypass grafting (CABG) in patients with coronary artery disease and mitral regurgitation (MR) remains unclear. 298 consecutive patients underwent CABG alone (n=196) or CABG+ MVR (n=102) between January 2003 and April 2008. Clinical data were collected and MR graded according to preoperative echocardiographic studies. Four severity grades of MR were determined and patients assigned accordingly. Echocardiographic follow-up was performed postoperatively to assess heart and valve function. Multivariate logistic regression analysis was performed for perioperative morbidity and mortality. Patients were comparable within the groups regarding age, gender, NYHA-class, ejection fraction and number of graft vessels. Perioperative mortality (10.8% vs. 5.1%, P < 0.05) and degree of MR were higher among CABG+MVR patients. Among patients with moderate to severe or severe MR, postoperative echocardiography showed an improvement of mitral regurgitation in 95% of CABG+MVR and in 64% of CABG only patients. In patients with mild or moderate MR, improvement rates of both groups were similar (74% and 69%, respectively). Postoperatively, ejection fraction increased in both groups (CABG+MVR: 31.3 +/- 8.5 to 36.4 +/- 11.2; CABG only: 29.9 +/- 6.1 to 33.3 +/- 8.1, P > 0.05). Significant predictors for peri-operative mortality were renal insufficiency, older age and NYHA class III/IV. For reduction of ischaemic MR, CABG+MVR is preferable in patients with moderate to severe or severe MR. Combined CABG+MVR procedures cannot be recommended for patients with a particular risk profile because of disproportionately high peri-operative mortality.

Impact of mitral valve repair in patients with mitral regurgitation undergoing coronary artery bypass grafting

Background — The benefit of concomitant mitral valve correction (replacement or reconstruction, MVR) and coronary artery bypass grafting (CABG) in patients with coronary artery disease and mitral regurgitation (MR) remains unclear.Patients and methods — 298 consecutive patients underwent CABG alone (n = 196) or CABG+ MVR (n = 102) between January 2003 and April 2008. Clinical data were collected and MR graded according to preoperative echocardiographic studies. Four severity grades of MR were determined and patients assigned accordingly. Echocardiographic follow-up was performed postoperatively to assess heart and valve function. Multivariate logistic regression analysis was performed for perioperative morbidity and mortality.Results — Patients were comparable within the groups regarding age, gender, NYHA-class, ejection fraction and number of graft vessels. Perioperative mortality (10.8% vs.5.1%, P < 0.05) and degree of MR were higher among CABG+MVR patients. Among patients with moderate to severe or severe MR, postoperative echocardiography showed an improvement of mitral regurgitation in 95% of CABG+MVR and in 64% of CABG only patients. In patients with mild or moderate MR, improvement rates of both groups were similar (74% and 69%, respectively). Postoperatively, ejection fraction increased in both groups (CABG+MVR: 31.3 ± 8.5 to 36.4 ± 11.2; CABG only: 29.9 ± 6.1 to 33.3 ± 8.1, P > 0.05). Significant predictors for peri-operative mortality were renal insufficiency, older age and NYHA class III/IV.Conclusions — For reduction of ischaemic MR, CABG+MVR is preferable in patients with moderate to severe or severe MR. Combined CABG+MVR procedures cannot be recommended for patients with a particular risk profile because of disproportionately high peri-operative mortality.

Impact of mitral valve repair in patients with mitral regurgitation undergoing coronary artery bypass grafting

Objectives: In patients with mitral regurgitation (MR) and advanced left ventricular (LV) dysfunction, it is not clear whether additional mitral valve repair (MVR, replacement or reconstruction) at the time of coronary artery bypass graft surgery is beneficial.