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Mitral valve repair or replacement for ischemic mitral regurgitation? The Italian Study on the Treatment of Ischemic Mitral Regurgitation (ISTIMIR).
J Thorac Cardiovasc Surg 2013; 145(1):128-39; discussion 137-8JT

Abstract

OBJECTIVE

It is uncertain whether mitral valve replacement is really inferior to mitral valve repair for the treatment of chronic ischemic mitral regurgitation. This multicenter study aimed at providing a contribution to this issue.

METHODS

Of 1006 patients with chronic ischemic mitral regurgitation and impaired left ventricular function (ejection fraction < 40%) operated on at 13 Italian institutions between 1996 and 2011, 298 (29.6%) underwent mitral valve replacement whereas 708 (70.4%) received mitral valve repair. Propensity scores were calculated by a nonparsimonious multivariable logistic regression, and 244 pairs of patients were matched successfully using calipers of width 0.2 standard deviation of the logit of the propensity scores. The postmatching median standardized difference was 0.024 (range, 0-0.037) and in none of the covariates did it exceed 10%.

RESULTS

Early deaths were 3.3% (n = 8) in mitral valve repair versus 5.3% (n = 13) in mitral valve replacement (P = .32). Eight-year survival was 81.6% ± 2.8% and 79.6% ± 4.8% (P = .42), respectively. Actual freedom from all-cause reoperation and valve-related reoperation were 64.3% ± 4.3% versus 80% ± 4.1%, and 71.3% ± 3.5% versus 85.5% ± 3.9 in mitral valve repair and mitral valve replacement, respectively (P < .001). Actual freedom from all valve-related complications was 68.3% ± 3.1% versus 69.9% ± 3.3% in mitral valve repair and mitral valve replacement, respectively (P = .78). Left ventricular function did not improved significantly, and it was comparable in the 2 groups postoperatively (36.9% vs 38.5%, P = .66). At competing regression analysis, mitral valve repair was a strong predictor of reoperation (hazard ratio, 2.84; P < .001).

CONCLUSIONS

Mitral valve replacement is a suitable option for patients with chronic ischemic mitral regurgitation and impaired left ventricular function. It provides better results in terms of freedom from reoperation with comparable valve-related complication rates.

Authors+Show Affiliations

Cardiac Surgery Unit, Community Hospital, Brescia, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

23127376

Citation

Lorusso, Roberto, et al. "Mitral Valve Repair or Replacement for Ischemic Mitral Regurgitation? the Italian Study On the Treatment of Ischemic Mitral Regurgitation (ISTIMIR)." The Journal of Thoracic and Cardiovascular Surgery, vol. 145, no. 1, 2013, pp. 128-39; discussion 137-8.
Lorusso R, Gelsomino S, Vizzardi E, et al. Mitral valve repair or replacement for ischemic mitral regurgitation? The Italian Study on the Treatment of Ischemic Mitral Regurgitation (ISTIMIR). J Thorac Cardiovasc Surg. 2013;145(1):128-39; discussion 137-8.
Lorusso, R., Gelsomino, S., Vizzardi, E., D'Aloia, A., De Cicco, G., Lucà, F., ... Calafiore, A. M. (2013). Mitral valve repair or replacement for ischemic mitral regurgitation? The Italian Study on the Treatment of Ischemic Mitral Regurgitation (ISTIMIR). The Journal of Thoracic and Cardiovascular Surgery, 145(1), pp. 128-39; discussion 137-8. doi:10.1016/j.jtcvs.2012.09.042.
Lorusso R, et al. Mitral Valve Repair or Replacement for Ischemic Mitral Regurgitation? the Italian Study On the Treatment of Ischemic Mitral Regurgitation (ISTIMIR). J Thorac Cardiovasc Surg. 2013;145(1):128-39; discussion 137-8. PubMed PMID: 23127376.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mitral valve repair or replacement for ischemic mitral regurgitation? The Italian Study on the Treatment of Ischemic Mitral Regurgitation (ISTIMIR). AU - Lorusso,Roberto, AU - Gelsomino,Sandro, AU - Vizzardi,Enrico, AU - D'Aloia,Antonio, AU - De Cicco,Giuseppe, AU - Lucà,Fabiana, AU - Parise,Orlando, AU - Gensini,Gian Franco, AU - Stefàno,Pierluigi, AU - Livi,Ugolino, AU - Vendramin,Igor, AU - Pacini,Davide, AU - Di Bartolomeo,Roberto, AU - Miceli,Antonio, AU - Varone,Egidio, AU - Glauber,Mattia, AU - Parolari,Alessandro, AU - Giuseppe Arlati,Francesco, AU - Alamanni,Francesco, AU - Serraino,Filiberto, AU - Renzulli,Attilio, AU - Messina,Antonio, AU - Troise,Giovanni, AU - Mariscalco,Giovanni, AU - Cottini,Marzia, AU - Beghi,Cesare, AU - Nicolini,Francesco, AU - Gherli,Tiziano, AU - Borghetti,Valentino, AU - Pardini,Alessandro, AU - Caimmi,Philippe-Primo, AU - Micalizzi,Ezio, AU - Fino,Carlo, AU - Ferrazzi,Paolo, AU - Di Mauro,Michele, AU - Calafiore,Antonio Maria, AU - ,, Y1 - 2012/11/03/ PY - 2012/04/15/received PY - 2012/07/19/revised PY - 2012/09/13/accepted PY - 2012/11/7/entrez PY - 2012/11/7/pubmed PY - 2013/3/13/medline SP - 128-39; discussion 137-8 JF - The Journal of thoracic and cardiovascular surgery JO - J. Thorac. Cardiovasc. Surg. VL - 145 IS - 1 N2 - OBJECTIVE: It is uncertain whether mitral valve replacement is really inferior to mitral valve repair for the treatment of chronic ischemic mitral regurgitation. This multicenter study aimed at providing a contribution to this issue. METHODS: Of 1006 patients with chronic ischemic mitral regurgitation and impaired left ventricular function (ejection fraction < 40%) operated on at 13 Italian institutions between 1996 and 2011, 298 (29.6%) underwent mitral valve replacement whereas 708 (70.4%) received mitral valve repair. Propensity scores were calculated by a nonparsimonious multivariable logistic regression, and 244 pairs of patients were matched successfully using calipers of width 0.2 standard deviation of the logit of the propensity scores. The postmatching median standardized difference was 0.024 (range, 0-0.037) and in none of the covariates did it exceed 10%. RESULTS: Early deaths were 3.3% (n = 8) in mitral valve repair versus 5.3% (n = 13) in mitral valve replacement (P = .32). Eight-year survival was 81.6% ± 2.8% and 79.6% ± 4.8% (P = .42), respectively. Actual freedom from all-cause reoperation and valve-related reoperation were 64.3% ± 4.3% versus 80% ± 4.1%, and 71.3% ± 3.5% versus 85.5% ± 3.9 in mitral valve repair and mitral valve replacement, respectively (P < .001). Actual freedom from all valve-related complications was 68.3% ± 3.1% versus 69.9% ± 3.3% in mitral valve repair and mitral valve replacement, respectively (P = .78). Left ventricular function did not improved significantly, and it was comparable in the 2 groups postoperatively (36.9% vs 38.5%, P = .66). At competing regression analysis, mitral valve repair was a strong predictor of reoperation (hazard ratio, 2.84; P < .001). CONCLUSIONS: Mitral valve replacement is a suitable option for patients with chronic ischemic mitral regurgitation and impaired left ventricular function. It provides better results in terms of freedom from reoperation with comparable valve-related complication rates. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/23127376/Mitral_valve_repair_or_replacement_for_ischemic_mitral_regurgitation_The_Italian_Study_on_the_Treatment_of_Ischemic_Mitral_Regurgitation__ISTIMIR__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(12)01154-3 DB - PRIME DP - Unbound Medicine ER -