Document Detail

Optimal surgical management of severe ischemic mitral regurgitation: to repair or to replace?
MedLine Citation:
PMID:  22054660     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Ischemic mitral regurgitation, a complication of myocardial infarction and coronary artery disease more generally, is associated with a high mortality rate and is estimated to affect 2.8 million Americans. With 1-year mortality rates as high as 40%, recent practice guidelines of professional societies recommend repair or replacement, but there remains a lack of conclusive evidence supporting either intervention. The choice between therapeutic options is characterized by the trade-off between reduced operative morbidity and mortality with repair versus a better long-term correction of mitral insufficiency with replacement. The long-term benefits of repair versus replacement remain unknown, which has led to significant variation in surgical practice.
METHODS AND RESULTS: This article describes the design of a prospective randomized clinical trial to evaluate the safety and effectiveness of mitral valve repair and replacement in patients with severe ischemic mitral regurgitation. This trial is being conducted as part of the Cardiothoracic Surgical Trials Network. This article addresses challenges in selecting a feasible primary end point, characterizing the target population (including the degree of mitral regurgitation) and analytical challenges in this high mortality disease.
CONCLUSIONS: The article concludes by discussing the importance of information on functional status, survival, neurocognition, quality of life, and cardiac physiology in therapeutic decision making.
Louis P Perrault; Alan J Moskowitz; Irving L Kron; Michael A Acker; Marissa A Miller; Keith A Horvath; Vinod H Thourani; Michael Argenziano; David A D'Alessandro; Eugene H Blackstone; Claudia S Moy; Joseph P Mathew; Judy Hung; Timothy J Gardner; Michael K Parides
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial     Date:  2011-11-04
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  143     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-18     Completed Date:  2012-07-11     Revised Date:  2014-06-12    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1396-403     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012. Published by Mosby, Inc.
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MeSH Terms
Heart Valve Prosthesis Implantation* / adverse effects,  mortality
Mitral Valve Annuloplasty* / adverse effects,  mortality
Mitral Valve Insufficiency / diagnosis,  etiology,  mortality,  surgery*
Myocardial Ischemia / complications*,  mortality
Prospective Studies
Research Design*
Severity of Illness Index
Treatment Outcome
United States
Grant Support

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

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