Document Detail


Meta-analysis of short-term and long-term survival following repair versus replacement for ischemic mitral regurgitation.
MedLine Citation:
PMID:  20727782     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The optimal surgical strategy for the management of ischemic mitral regurgitation (IMR) is still debated. The purpose of this study was to perform a meta-analysis summarizing the evidence favoring one technique over another (repair vs replacement). A search of the English literature in PubMed was performed using 'ischemic mitral regurgitation' and 'repair or replacement or annuloplasty' in the title/abstract field. Articles were excluded if they lacked a direct comparison of repair versus replacement, or used Teflon/pericardial strip or suture annuloplasty in >10% of the repairs. Nine articles were selected for the final analysis. All studies except one were relatively recent (2004-2009). The patient characteristics between treatment groups were similar across studies. All studies excluded patients with degenerative etiology and used a rigorous definition of IMR. Most patients had concomitant coronary artery bypass graft. In the patients with mitral valve replacement, at least the posterior and, in many cases, the entire subvalvular apparatus were preserved. Mean ejection fraction and proportion of patients with severe ventricular dysfunction were similar between the repair and replacement groups. The odds ratios for the studies, comparing replacement to repair, ranged from 0.884 to 17.241 for short-term mortality and the hazard ratios ranged from 0.677 to 3.205 for long-term mortality. There was a significantly increased likelihood of both short-term mortality (summary odds ratio 2.667 (95% confidence interval (CI) 1.859-3.817)) and long-term mortality (summary hazard ratio 1.352 (95% CI 1.131-1.618)) for the replacement group compared to the repair group. Based on the meta-analysis of the current relevant literature, mitral valve repair for IMR is associated with better short-term and long-term survival compared to mitral valve replacement. Our conclusion should be interpreted in the context of the inherent limitations of a meta-analysis of retrospective studies including heterogeneity of patient characteristics, which may have influenced the physician's decision to perform mitral valve repair or replacement. In the absence of any published randomized studies, mitral procedure selection should be individualized.
Authors:
Christina M Vassileva; Theresa Boley; Stephen Markwell; Stephen Hazelrigg
Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Review     Date:  2010-08-19
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  39     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-15     Completed Date:  2011-08-31     Revised Date:  2012-03-05    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  295-303     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Affiliation:
Division of Cardiothoracic Surgery, SIU School of Medicine, Springfield, IL 62794-9638, USA. cvassileva@siumed.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation / methods*,  mortality
Humans
Male
Middle Aged
Mitral Valve / surgery*
Mitral Valve Insufficiency / etiology,  physiopathology,  surgery*
Myocardial Infarction / complications
Survival Analysis
Treatment Outcome
Ventricular Function / physiology
Comments/Corrections
Comment In:
Eur J Cardiothorac Surg. 2012 Jan;41(1):236-7; author reply 237-8   [PMID:  21640600 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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