open access

Vol 26, No 3 (2019)
Original articles — Clinical cardiology
Published online: 2018-01-25
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Long-term outcomes of mitral valve annuloplasty versus subvalvular sparing replacement for severe ischemic mitral regurgitation

Baotong Li, Hengchao Wu, Hansong Sun, Jianping Xu, Yunhu Song, Wei Wang, Shuiyun Wang
DOI: 10.5603/CJ.a2018.0006
·
Pubmed: 29570209
·
Cardiol J 2019;26(3):265-274.

open access

Vol 26, No 3 (2019)
Original articles — Clinical cardiology
Published online: 2018-01-25

Abstract

Background: 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. The purpose of this study was to evaluate the long-term outcomes in patients with severe CIMR undergoing mitral valve annuloplasty (MVA) versus subvalvular sparing mitral valve replacement (MVR). 

Methods: 392 consecutive patients who underwent MVA or subvalvular sparing MVR for treatment of severe CIMR were retrospectively reviewed.

Results: After adjustment for baseline differences with multivariable regression analysis at 53 months follow-up (interquartile range, 34–81 months), there was no significant difference between the two groups for risk of major adverse cardiac or cerebrovascular events (MACCE), cardiac death, or all-cause death. Propensity score matching extracted 77 pairs. During the follow-up, compared with the MVR group, both the left atrium and left ventricle end-diastolic diameter were markedly larger (p = 0.013 and p = 0.033, respectively), and the incidence of mitral regurgitation recurrence was significantly higher in the MVA group (p < 0.001). No significant difference was observed between the two propensity score-matched groups in composite in-hospital outcomes, overall survival, freedom from cardiac death or MACCE, except subvalvular sparing MVR was associated with a lower incidence of hospitalization for heart failure than MVA (p = 0.015).

Conclusions: Subvalvular sparing MVR is a suitable management of patients with severe CIMR, it is more favorable to ventricular remodeling and is associated with a lower incidence of hospitalization for heart failure than MVA.

Abstract

Background: 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. The purpose of this study was to evaluate the long-term outcomes in patients with severe CIMR undergoing mitral valve annuloplasty (MVA) versus subvalvular sparing mitral valve replacement (MVR). 

Methods: 392 consecutive patients who underwent MVA or subvalvular sparing MVR for treatment of severe CIMR were retrospectively reviewed.

Results: After adjustment for baseline differences with multivariable regression analysis at 53 months follow-up (interquartile range, 34–81 months), there was no significant difference between the two groups for risk of major adverse cardiac or cerebrovascular events (MACCE), cardiac death, or all-cause death. Propensity score matching extracted 77 pairs. During the follow-up, compared with the MVR group, both the left atrium and left ventricle end-diastolic diameter were markedly larger (p = 0.013 and p = 0.033, respectively), and the incidence of mitral regurgitation recurrence was significantly higher in the MVA group (p < 0.001). No significant difference was observed between the two propensity score-matched groups in composite in-hospital outcomes, overall survival, freedom from cardiac death or MACCE, except subvalvular sparing MVR was associated with a lower incidence of hospitalization for heart failure than MVA (p = 0.015).

Conclusions: Subvalvular sparing MVR is a suitable management of patients with severe CIMR, it is more favorable to ventricular remodeling and is associated with a lower incidence of hospitalization for heart failure than MVA.

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Keywords

chronic ischemic mitral regurgitation; mitral valve annuloplast; subvalvular sparing mitral valve replacement; coronary artery bypass grafting

About this article
Title

Long-term outcomes of mitral valve annuloplasty versus subvalvular sparing replacement for severe ischemic mitral regurgitation

Journal

Cardiology Journal

Issue

Vol 26, No 3 (2019)

Pages

265-274

Published online

2018-01-25

DOI

10.5603/CJ.a2018.0006

Pubmed

29570209

Bibliographic record

Cardiol J 2019;26(3):265-274.

Keywords

chronic ischemic mitral regurgitation
mitral valve annuloplast
subvalvular sparing mitral valve replacement
coronary artery bypass grafting

Authors

Baotong Li
Hengchao Wu
Hansong Sun
Jianping Xu
Yunhu Song
Wei Wang
Shuiyun Wang

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