Moreover, healing duration of the mv wound is not well known. Repair or replacement in ischemic mitral regurgitation. Twoyear outcomes following mitral valve repair versus. Mitral valve repair versus replacement degenerative, ischemic, rheumatic and infectious endocarditis processes are responsible for mitral valve disease in adults. Mitral valve regurgitation mr is the most common valvular heart disease.
Mitral valve repair versus replacement for ischemic mitral. Mitral regurgitation mr affects nearly 2 million americans with coronary artery disease, conferring an increased risk of heart failure, arrhythmia, and death. Superior transseptal approach to mitral valve is associated with a higher need for pacemaker implantation than the left atrial approach. Costeffectiveness of mitral valve repair versus replacement for.
Diagnosing and managing mr is often challenging and requires a structured approach, integrating findings on history, physical examination, and imaging. The benefits of mitral valve repair mvr over replacement mvr have been firmly established in degenerative mitral valve disease. Mitralvalve repair versus replacement for severe ischemic mitral regurgitation article pdf available in new england journal of medicine 3701 november 20 with 183 reads how we measure reads. The search terms ischemic or ischaemic and mitral valve and repair or replacement or annuloplasty and coronary artery bypass grafting were entered as mesh terms and keywords. However, clinical studies have shown that without exercise training et, there is no significant postoperative exercise tolerance improvement. The valve is leaky mitral valve regurgitation the valve is narrowed and doesnt open properly mitral valve stenosis. This was a study to compare the results of mitral valve mv repair and mv replacement for the treatment of functional mitral regurgitation mr in advanced dilated and ischemic cardiomyopathy dcm. Mitralvalve repair versus replacement for severe ischemic. Practice guidelines recommend surgery for patients with. Mitral valve repair versus replacement for severe ischemic mitral regurgitation michael acker, md for the ctsn investigators aha november 20. Is repair preferable to replacement for ischemic mitral regurgitation.
The italian study on the treatment of ischemic mitral regurgitation istimir. I am jay widmer, cardiovascular fellow here at the mayo clinic, and today on medscape cardiology i will be discussing repair vs replacement for severe ischemic mitral regurgitation mr. Practice guidelines recommend surgery for patients with a severe form of this condition but acknowledge that the supporting evidence for repair or replacement is limited. A computerized search was performed using pubmed, embase, ovid medline and cochrane library. This study compared the degree of left ventricular reverse remodeling in patients with severe ischemic mitral regurgitation who had either mitral valve repair or mitral valve replacement surgery. In a multicenter trial, 251 patients scheduled to undergo clinically indicated surgical intervention for severe ischemic mr with or without concomitant coronary revascularization were randomly assigned to undergo either mitral valve repair or chordalsparing replacement in order to evaluate efficacy and safety. Jan 24, 2018 although practice guidelines recommend surgery for patients with severe chronic ischemic mitral regurgitation cimr, they do not specify whether to repair or replace the mitral valve. Mitral valve repair or replacement for ischemic mitral regurgitation. We randomly assigned 251 patients with severe ischemic mitral regurgitation to undergo either mitralvalve repair or chordalsparing replacement in order to evaluate efficacy and safety. Mitral replacement or repair for functional mitral. Our costeffectiveness analysis predicts potential savings in cost and gains in qualityadjusted survival at 10 years when mitral valve replacement is compared with repair for severe ischemic mr. Commonly referred to as ischemic mitral regurgitation imr, this condition has generally been attributed to papillary muscle displacement.
Outcomes of mitral valve repair versus replacement in the. Mitral valve repair has been widely regarded as the optimal surgical procedure to treat mitral valve dysfunction of all etiologies and is currently the most commonly performed surgical procedure for mitral valve regurgitation in north america. Early exercise training after mitral valve repair chest. They obtained invaluable scientific data from the study. Despite the publication of a rigorous metaanalysis addressing the controversy of repair or replacement for a severely regurgitant mitral valve in ischemic patients, the authors of this article 1 commented that a prospective randomized trial 2 was being developed to clarify this dilemma. Mitral valve replacement mitral valve repair center. Although practice guidelines recommend surgery for patients with severe chronic ischemic mitral regurgitation cimr, they do not specify whether to repair or replace the mitral valve. Backgroundwhen compared to mitral valve replacement mvr, mitral valve repair mvrp is associated with better survival in patients with organic mitral regurgitation mr. Costeffectiveness of mitral valve repair versus replacement for severe ischemic mitral regurgitation. Chronic ischemic mitral regurgitation imr is a common and. Background ischemic mitral regurgitation is associated with a substantial risk of death. Mitral valve regurgitation in the contemporary era jacc. Mitral valve repair versus replacement for severe ischemic mitral regurgitation. Although practice guidelines recommend surgery for patients with severe chronic ischemic mitral regurgitation cimr, they do not specify.
New findings in percutaneous mitral valve repair and replacement for ischemic mr will also be described. Mitral valve repair versus mitral valve replacement on perioperative mortality. Surgical mitral valve mv repair is now the best technique to correct mitral regurgitation mr. Patients undergoing mitral valve repair may have a reduced incidence of thromboembolism and reduced necessity for anticoagulation compared with patients.
Ackerma,paridesmk,perraultlp,moskowitzaj,gelijnsac,voisinep,etal. Ischemic mitral regurgitation on the threshold of a solution. Decisions regarding treatment depend on knowledge of the. We compared mitral repair to replacement in patients with chronic ischemic mitral regurgitation imr, due to left ventricular dysfunction lvimr or papillary muscle infarction pmimr. Mitral valve replacement is a procedure whereby the diseased mitral valve of a patients heart is replaced by either a mechanical or tissue bioprosthetic valve. The aim of this study was to examine our eight years experience of surgical treatment in patients with imr, and to compare outcomes of mitral valve repair versus replacement with concomitant coronary artery bypass grafting cabg. Mitral valve replacement was found to provide a more durable correction of mitral regurgitation and fewer cardiovascular readmissions. Mitral valve annuloplasty versus replacement for severe ischemic. However, there is an important controversy about the type of surgical treatment that should be used in patients with ischemic mr. Repair versus replacement for ischemic mitral regurgitation article pdf available in journal of tehran university heart center 32. Mitral valve annuloplasty versus replacement for severe.
Primary mr is a disease of the mitral valve apparatus, whereas secondary mr is a disease of the left ventricle. Mitral valve repair for ischemic mitral regurgitation. Mack said at the annual cardiovascular conference at snowmass. Predicting recurrent mitral regurgitation after mitral valve repair for severe ischemic mitral regurgitation. Mitral repair versus replacement for ischemic mitral. Mitral valve repair versus replacement in patients with ischemic.
After adjusting for risk factors and propensity score, the type of procedure was not an independent predictor of operative and overall mortality. There are several reasons to prefer a mitral valve repair to a replacement such as avoidance of anticoagulation, lower risk of endocarditis, better ventricular function, desire to keep ones own tissue, but from an epidemiological viewpoint, the prime value of the repair operation lies in the. Repair or replace ischemic mitral regurgitation during. These findings may indicate that a mitral valve replacement should be the first choice treatment for severe ischemic mitral regurgitation. Mitral valve repair versus replacement pubmed central pmc. Surgical treatment of ischemic mitral regurgitation. Mitral valve repair versus replacement in patients with. Ischemic mitral regurgitation reduxto repair or to replace. Costeffectiveness of mitral valve repair versus replacement.
Methods patients with imr undergoing repair n 65 or replacement n 7 from 1990 to 2001 were evaluated. A clear message from the firstever randomized trial of surgical mitral valve repair versus replacement for patients with severe ischemic mitral regurgitation is that replacement should be utilized more liberally, dr. Mitral valve repair versus replacement mick annals of. Mitral valve repair versus replacement for severe ischemic. Repair or replacement for severe ischemic mitral regurgitation ncbi. Methods study design and oversight we randomly assigned patients with chronic, severe ischemic mitral regurgitation, in a 1. Article information, pdf download for ischemic mitral regurgitation. Comparing the effectiveness of repairing versus replacing the. Mitral regurgitation canadian cardiovascular society. Pdf mitralvalve repair versus replacement for severe. Pdf repair versus replacement for ischemic mitral regurgitation. The optimal management of ischemic mitral regurgitation imr is controversial. Repair versus replacement for ischemic mitral regurgitation.
These results can be represented with a stronger level of evidence by utilizing a robust statistical method called bootstrapping. Ischemic mitral regurgitation is associated with a substantial risk of death. Dec 11, 2008 comparing the effectiveness of repairing versus replacing the hearts mitral valve in people with severe chronic ischemic mitral regurgitation the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Mitralvalve repair versus replacement for severe ischemic mitral. We randomly assigned patients with chronic, severe ischemic mitral regurgitation, in a 1. Unlike acute ischemic mitral regurgitation, which is caused by papillary muscle rupture and flail leaflet, in functional ischemic mitral regurgitation the mitral apparatus is structurally intact but its geometry and the balances between opening and closing forces are altered in a way that prevents effective closure see chapter 28. One patient in the repair group later underwent mvr due to severe regurgitation postoperatively.
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