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Mitral valve replacement versus annuloplasty for treating severe functional mitral regurgitation.
MedLine Citation:
PMID:  24005597     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: To improve the clinical outcome of patients with severe functional mitral regurgitation (FMR) associated with ischemic cardiomyopathy (ICM), we compared the therapeutic efficacy of mitral annuloplasty (MAP) with that of mitral valve replacement (MVR).
METHODS: In a retrospective observation 63 consecutive patients underwent mitral valve surgery for severe ICM-FMR from November 1999 to March 2012. All patients had severe FMR (regurgitant volume >60 ml/beat) with Carpentier type I and type IIIb disease. Mean RV was 74.0 ± 35.0 ml/beat and coaptation depth was 12.7 ± 3.0 mm. Twenty-six patients (41.3 %) were treated by MVR with sparing of the subvalvular apparatus and 37 (58.7 %) by MAP.
RESULTS: Total in-hospital mortality was 6.3 %. Kaplan-Meier survival estimates at 1 and 5 years were 84.2 and 78.6 % in the MVR group and 82.6 and 71.6 % in the MAP group, with no significant difference between groups (p = 0.758). Freedom from major adverse cardiac and cerebrovascular events (MACCE) at 5 years was 66.9 % for patients treated by MVR and 64.1 % for those treated by MAP (p = 0.866). At the last follow-up visit, >grade II MR had recurred in 4 annuloplasty patients (10.8 %). In multivariate analysis, independent predictors of increased late death and MACCE were significantly associated with residual pulmonary hypertension (late death: odds ratio = 25.0, p = 0.0009; MACCE: odds ratio = 31.3, p = 0.0001).
CONCLUSIONS: Mitral valve replacement with sparing of the subvalvular apparatus is a safe and effective surgical alternative for patients with severe FMR.
Authors:
Kazunori Yoshida; Kenji Okada; Shunsuke Miyahara; Atsushi Omura; Takeshi Inoue; Hitoshi Minami; Yutaka Okita
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-9-5
Journal Detail:
Title:  General thoracic and cardiovascular surgery     Volume:  -     ISSN:  1863-6713     ISO Abbreviation:  Gen Thorac Cardiovasc Surg     Publication Date:  2013 Sep 
Date Detail:
Created Date:  2013-9-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101303952     Medline TA:  Gen Thorac Cardiovasc Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Cardiovascular Surgery, Nishinomiya Watanabe Cardiovascular Center, 3-25, Ikeda-cho, Nishinomiya-shi, 662-0911, Japan, kazuy_nwcc@bca.bai.ne.jp.
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