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Mitral valve repair versus replacement in patients with ischaemic mitral regurgitation and depressed ejection fraction: risk factors for early and mid-term mortality†.

Abstract

OBJECTIVES

Mitral valve (MV) surgery for ischaemic mitral regurgitation (IMR) in patients with depressed left ventricular ejection fraction (LVEF) is associated with poor outcomes. The optimal surgical strategy for IMR in these patients remains controversial. The objective of this study was to compare the early mortality and mid-term survival of MV repair versus MV replacement in patients with IMR and depressed LVEF undergoing coronary artery bypass grafting (CABG).

METHODS

A retrospective, observational, cohort study was undertaken of prospectively collected data on 126 consecutive CABG patients with IMR and LVEF <40% undergoing either MV repair (n = 98, 78%) or MV replacement (n = 28, 22%) between July 2002 and February 2011.

RESULTS

The overall mortality rate was 7.9% (n = 10). MV replacement was associated with a 4-fold increase in the risk of death compared with MV repair [17.9%, n = 5 vs 5.1%, n = 5; odds ratio (OR) 4.04, 95% confidence interval (CI) 1.08-15.1, P = 0.04]. However, after adjusting for preoperative risk factors, the type of surgical procedure was not an independent risk factor for early mortality (OR 0.1, 95% CI 0.01-31, P = 0.7). Multivariable analysis showed that preoperative LVEF (OR 0.8, 95% CI 0.6-0.9, P = 0.018), preoperative B-type natriuretic peptide (BNP) levels (OR 1.01, 95% CI 1-1.02, P = 0.025), preoperative left ventricle end-systolic diameter (OR 0.8, 95% CI 0.7-1.0, P = 0.05) and preoperative left atrial diameter (OR 1.3, 95% CI 1.0-1.6, P = 0.015) were independent risk factors of early mortality. At the median follow-up of 45 months (interquartile range 20-68 months), the mid-term survival rate was 74% in the MV repair group and 70% in the MV replacement group (P = 0.08). At follow-up, predictors of worse survival were BNP levels [hazard ratio (HR) 1.0, 95% CI 1.0-1.01, P = 0.047], preoperative renal failure (HR 4.6, 95% CI 1.1-20.3, P = 0.039) and preoperative atrial fibrillation (HR 3.3, 95% CI 1.1-10, P = 0.032).

CONCLUSIONS

MV repair in CABG patients with IMR and depressed LVEF is not superior to MV replacement with regard to operative early mortality and mid-term survival.

Authors+Show Affiliations

Department of Adult Cardiac Surgery, Fondazione Toscana G. Monasterio, Massa, Italy.Department of Adult Cardiac Surgery, Fondazione Toscana G. Monasterio, Massa, Italy Bristol Heart Institute, University of Bristol, UK antoniomiceli79@alice.it.Department of Adult Cardiac Surgery, Fondazione Toscana G. Monasterio, Massa, Italy.Department of Adult Cardiac Surgery, Fondazione Toscana G. Monasterio, Massa, Italy.Department of Adult Cardiac Surgery, Fondazione Toscana G. Monasterio, Massa, Italy.Department of Adult Cardiac Surgery, Fondazione Toscana G. Monasterio, Massa, Italy.Department of Adult Cardiac Surgery, Fondazione Toscana G. Monasterio, Massa, Italy.Department of Adult Cardiac Surgery, Fondazione Toscana G. Monasterio, Massa, Italy.Department of Adult Cardiac Surgery, Fondazione Toscana G. Monasterio, Massa, Italy.Department of Adult Cardiac Surgery, Fondazione Toscana G. Monasterio, Massa, Italy.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

24676552

Citation

Lio, Antonio, et al. "Mitral Valve Repair Versus Replacement in Patients With Ischaemic Mitral Regurgitation and Depressed Ejection Fraction: Risk Factors for Early and Mid-term Mortality†." Interactive Cardiovascular and Thoracic Surgery, vol. 19, no. 1, 2014, pp. 64-9.
Lio A, Miceli A, Varone E, et al. Mitral valve repair versus replacement in patients with ischaemic mitral regurgitation and depressed ejection fraction: risk factors for early and mid-term mortality†. Interact Cardiovasc Thorac Surg. 2014;19(1):64-9.
Lio, A., Miceli, A., Varone, E., Canarutto, D., Di Stefano, G., Della Pina, F., ... Glauber, M. (2014). Mitral valve repair versus replacement in patients with ischaemic mitral regurgitation and depressed ejection fraction: risk factors for early and mid-term mortality†. Interactive Cardiovascular and Thoracic Surgery, 19(1), pp. 64-9. doi:10.1093/icvts/ivu066.
Lio A, et al. Mitral Valve Repair Versus Replacement in Patients With Ischaemic Mitral Regurgitation and Depressed Ejection Fraction: Risk Factors for Early and Mid-term Mortality†. Interact Cardiovasc Thorac Surg. 2014;19(1):64-9. PubMed PMID: 24676552.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mitral valve repair versus replacement in patients with ischaemic mitral regurgitation and depressed ejection fraction: risk factors for early and mid-term mortality†. AU - Lio,Antonio, AU - Miceli,Antonio, AU - Varone,Egidio, AU - Canarutto,Daniele, AU - Di Stefano,Gioia, AU - Della Pina,Francesca, AU - Gilmanov,Daniyar, AU - Murzi,Michele, AU - Solinas,Marco, AU - Glauber,Mattia, Y1 - 2014/03/27/ PY - 2014/3/29/entrez PY - 2014/3/29/pubmed PY - 2015/2/11/medline KW - Ischaemic mitral regurgitation KW - Left ventricular dysfunction KW - Mitral valve surgery SP - 64 EP - 9 JF - Interactive cardiovascular and thoracic surgery JO - Interact Cardiovasc Thorac Surg VL - 19 IS - 1 N2 - OBJECTIVES: Mitral valve (MV) surgery for ischaemic mitral regurgitation (IMR) in patients with depressed left ventricular ejection fraction (LVEF) is associated with poor outcomes. The optimal surgical strategy for IMR in these patients remains controversial. The objective of this study was to compare the early mortality and mid-term survival of MV repair versus MV replacement in patients with IMR and depressed LVEF undergoing coronary artery bypass grafting (CABG). METHODS: A retrospective, observational, cohort study was undertaken of prospectively collected data on 126 consecutive CABG patients with IMR and LVEF <40% undergoing either MV repair (n = 98, 78%) or MV replacement (n = 28, 22%) between July 2002 and February 2011. RESULTS: The overall mortality rate was 7.9% (n = 10). MV replacement was associated with a 4-fold increase in the risk of death compared with MV repair [17.9%, n = 5 vs 5.1%, n = 5; odds ratio (OR) 4.04, 95% confidence interval (CI) 1.08-15.1, P = 0.04]. However, after adjusting for preoperative risk factors, the type of surgical procedure was not an independent risk factor for early mortality (OR 0.1, 95% CI 0.01-31, P = 0.7). Multivariable analysis showed that preoperative LVEF (OR 0.8, 95% CI 0.6-0.9, P = 0.018), preoperative B-type natriuretic peptide (BNP) levels (OR 1.01, 95% CI 1-1.02, P = 0.025), preoperative left ventricle end-systolic diameter (OR 0.8, 95% CI 0.7-1.0, P = 0.05) and preoperative left atrial diameter (OR 1.3, 95% CI 1.0-1.6, P = 0.015) were independent risk factors of early mortality. At the median follow-up of 45 months (interquartile range 20-68 months), the mid-term survival rate was 74% in the MV repair group and 70% in the MV replacement group (P = 0.08). At follow-up, predictors of worse survival were BNP levels [hazard ratio (HR) 1.0, 95% CI 1.0-1.01, P = 0.047], preoperative renal failure (HR 4.6, 95% CI 1.1-20.3, P = 0.039) and preoperative atrial fibrillation (HR 3.3, 95% CI 1.1-10, P = 0.032). CONCLUSIONS: MV repair in CABG patients with IMR and depressed LVEF is not superior to MV replacement with regard to operative early mortality and mid-term survival. SN - 1569-9285 UR - https://www.unboundmedicine.com/medline/citation/24676552/Mitral_valve_repair_versus_replacement_in_patients_with_ischaemic_mitral_regurgitation_and_depressed_ejection_fraction:_risk_factors_for_early_and_mid_term_mortality†_ L2 - https://academic.oup.com/icvts/article-lookup/doi/10.1093/icvts/ivu066 DB - PRIME DP - Unbound Medicine ER -