Edge-to-edge with partial band mitral valve repair compared to replacement and undersized restrictive annuloplasty for ischemic mitral regurgitationCentral MessagePerspective
Objective: Evidence supports replacement over repair for ischemic mitral regurgitation due to improved durability; however, the latter often involves an undersized ring annuloplasty that does not include edge-to-edge approximation. The objective of this study was to evaluate the outcomes of replacem...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-02-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250723004121 |
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| author | Alex Nantsios, MD Aryan Ahmadvand, BHSc Ian G. Burwash, MD, FRCPC Vincent Chan, MD, MPH, FRCSC Ming Hao Guo, MD, MSc Thierry Mesana, MD, PhD, FRCSC David Messika-Zeitoun, MD Tim Ramsay, PhD Fraser D. Rubens, MD, MSc, FACS, FRCSC |
| author_facet | Alex Nantsios, MD Aryan Ahmadvand, BHSc Ian G. Burwash, MD, FRCPC Vincent Chan, MD, MPH, FRCSC Ming Hao Guo, MD, MSc Thierry Mesana, MD, PhD, FRCSC David Messika-Zeitoun, MD Tim Ramsay, PhD Fraser D. Rubens, MD, MSc, FACS, FRCSC |
| author_sort | Alex Nantsios, MD |
| collection | DOAJ |
| description | Objective: Evidence supports replacement over repair for ischemic mitral regurgitation due to improved durability; however, the latter often involves an undersized ring annuloplasty that does not include edge-to-edge approximation. The objective of this study was to evaluate the outcomes of replacement, edge-to-edge leaflet approximation with mild-undersized annuloplasty and undersized ring annuloplasty for ischemic mitral regurgitation. Methods: This is a single-center retrospective study of patients undergoing mitral surgery for moderate-severe or greater ischemic mitral regurgitation, between 2004 and 2020, with mild-undersized annuloplasty, mitral valve replacement, or undersized restrictive annuloplasty (undersized ring annuloplasty). The primary outcome was all-cause mortality. Secondary outcomes included first recurrence of mitral regurgitation, heart failure hospitalization, and composite of valve-related events (bleeding, thromboembolism, endocarditis, and mitral valve reoperation). Results: There were 121, 93, and 78 patients in the mitral valve replacement, mild-undersized annuloplasty, and undersized restrictive annuloplasty groups, respectively, with a median follow-up of 3.1, 5.9, and 3.8 years, respectively. Both mitral valve replacement (hazard ratio, 1.87; 95% CI, 1.029-3.415) and undersized restrictive annuloplasty (hazard ratio, 2.73; 95% CI, 1.480-5.061) were associated with worse survival compared with mild-undersized annuloplasty. At 2 years, the rate of mild-moderate mitral regurgitation was greater in the mild-undersized annuloplasty group compared with the mitral valve replacement group (P = .001) but less than in the undersized restrictive annuloplasty group (P = .001). The rate of recurrent moderate or greater mitral regurgitation at 2 years was similar between mild-undersized annuloplasty and mitral valve replacement groups but significantly higher after undersized restrictive annuloplasty (P < .0001). Mitral valve replacement and undersized restrictive annuloplasty were associated with a significant increase in the incidence of first heart failure hospitalization compared with mild-undersized annuloplasty (P < .001 and P = .001, respectively). Mitral valve replacement was associated with an increased incidence of valve-related events compared with mild-undersized annuloplasty (P = .002). Conclusions: Surgical edge-to-edge approximation in addition to a mild-undersizing annuloplasty offers similar durability compared with replacement, with a lower rate of hospitalization for heart failure, and may confer a survival advantage. |
| format | Article |
| id | doaj-art-6cdebce0dbca4d8f8cb1e16f0478f4ad |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-6cdebce0dbca4d8f8cb1e16f0478f4ad2025-08-20T04:01:57ZengElsevierJTCVS Techniques2666-25072024-02-0123264310.1016/j.xjtc.2023.10.028Edge-to-edge with partial band mitral valve repair compared to replacement and undersized restrictive annuloplasty for ischemic mitral regurgitationCentral MessagePerspectiveAlex Nantsios, MD0Aryan Ahmadvand, BHSc1Ian G. Burwash, MD, FRCPC2Vincent Chan, MD, MPH, FRCSC3Ming Hao Guo, MD, MSc4Thierry Mesana, MD, PhD, FRCSC5David Messika-Zeitoun, MD6Tim Ramsay, PhD7Fraser D. Rubens, MD, MSc, FACS, FRCSC8Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaDivision of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaDivision of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaDivision of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaDivision of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaDivision of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaDivision of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaSchool of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, CanadaDivision of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Address for reprints: Fraser D. Rubens, MD, MSc, FACS, FRCSC, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, Ontario K1Y4W7, Canada.Objective: Evidence supports replacement over repair for ischemic mitral regurgitation due to improved durability; however, the latter often involves an undersized ring annuloplasty that does not include edge-to-edge approximation. The objective of this study was to evaluate the outcomes of replacement, edge-to-edge leaflet approximation with mild-undersized annuloplasty and undersized ring annuloplasty for ischemic mitral regurgitation. Methods: This is a single-center retrospective study of patients undergoing mitral surgery for moderate-severe or greater ischemic mitral regurgitation, between 2004 and 2020, with mild-undersized annuloplasty, mitral valve replacement, or undersized restrictive annuloplasty (undersized ring annuloplasty). The primary outcome was all-cause mortality. Secondary outcomes included first recurrence of mitral regurgitation, heart failure hospitalization, and composite of valve-related events (bleeding, thromboembolism, endocarditis, and mitral valve reoperation). Results: There were 121, 93, and 78 patients in the mitral valve replacement, mild-undersized annuloplasty, and undersized restrictive annuloplasty groups, respectively, with a median follow-up of 3.1, 5.9, and 3.8 years, respectively. Both mitral valve replacement (hazard ratio, 1.87; 95% CI, 1.029-3.415) and undersized restrictive annuloplasty (hazard ratio, 2.73; 95% CI, 1.480-5.061) were associated with worse survival compared with mild-undersized annuloplasty. At 2 years, the rate of mild-moderate mitral regurgitation was greater in the mild-undersized annuloplasty group compared with the mitral valve replacement group (P = .001) but less than in the undersized restrictive annuloplasty group (P = .001). The rate of recurrent moderate or greater mitral regurgitation at 2 years was similar between mild-undersized annuloplasty and mitral valve replacement groups but significantly higher after undersized restrictive annuloplasty (P < .0001). Mitral valve replacement and undersized restrictive annuloplasty were associated with a significant increase in the incidence of first heart failure hospitalization compared with mild-undersized annuloplasty (P < .001 and P = .001, respectively). Mitral valve replacement was associated with an increased incidence of valve-related events compared with mild-undersized annuloplasty (P = .002). Conclusions: Surgical edge-to-edge approximation in addition to a mild-undersizing annuloplasty offers similar durability compared with replacement, with a lower rate of hospitalization for heart failure, and may confer a survival advantage.http://www.sciencedirect.com/science/article/pii/S2666250723004121edge-to-edge repairheart failureischemic mitral regurgitationmitral valve repairmitral valve replacement |
| spellingShingle | Alex Nantsios, MD Aryan Ahmadvand, BHSc Ian G. Burwash, MD, FRCPC Vincent Chan, MD, MPH, FRCSC Ming Hao Guo, MD, MSc Thierry Mesana, MD, PhD, FRCSC David Messika-Zeitoun, MD Tim Ramsay, PhD Fraser D. Rubens, MD, MSc, FACS, FRCSC Edge-to-edge with partial band mitral valve repair compared to replacement and undersized restrictive annuloplasty for ischemic mitral regurgitationCentral MessagePerspective JTCVS Techniques edge-to-edge repair heart failure ischemic mitral regurgitation mitral valve repair mitral valve replacement |
| title | Edge-to-edge with partial band mitral valve repair compared to replacement and undersized restrictive annuloplasty for ischemic mitral regurgitationCentral MessagePerspective |
| title_full | Edge-to-edge with partial band mitral valve repair compared to replacement and undersized restrictive annuloplasty for ischemic mitral regurgitationCentral MessagePerspective |
| title_fullStr | Edge-to-edge with partial band mitral valve repair compared to replacement and undersized restrictive annuloplasty for ischemic mitral regurgitationCentral MessagePerspective |
| title_full_unstemmed | Edge-to-edge with partial band mitral valve repair compared to replacement and undersized restrictive annuloplasty for ischemic mitral regurgitationCentral MessagePerspective |
| title_short | Edge-to-edge with partial band mitral valve repair compared to replacement and undersized restrictive annuloplasty for ischemic mitral regurgitationCentral MessagePerspective |
| title_sort | edge to edge with partial band mitral valve repair compared to replacement and undersized restrictive annuloplasty for ischemic mitral regurgitationcentral messageperspective |
| topic | edge-to-edge repair heart failure ischemic mitral regurgitation mitral valve repair mitral valve replacement |
| url | http://www.sciencedirect.com/science/article/pii/S2666250723004121 |
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