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Mitral valve repair for ischemic mitral regurgitation: lessons from the Cardiothoracic Surgical Trials Network randomized study.
J Thorac Dis 2016; 8(1):E94-9JT

Abstract

Approximately 30% to 50% of patients will develop ischemic mitral regurgitation (MR) after a myocardial infarction, which is a result of progressive left ventricular remodeling and dysfunction of the subvalvular apparatus, and portends a poor long-term prognosis. Surgical treatment is centered on mitral valve repair utilizing a restrictive annuloplasty, or valve replacement with preservation of the subvalvular apparatus. In the recent Cardiothoracic Surgical Trials Network (CSTN) study, patients with severe ischemic MR were randomized to mitral valve repair with a restrictive annuloplasty versus chordal-sparing valve replacement, and concomitant coronary artery bypass grafting, if indicated. At 2-year follow-up, mitral valve repair was associated with a significantly higher incidence of moderate or greater recurrent MR and heart failure, with no difference in the indices of left ventricular reverse remodeling, as compared with valve replacement. The current appraisal aims to provide insight into the CSTN trial results, and discusses the evidence supporting a pathophysiologic-guided repair strategy incorporating combined annuloplasty and subvalvular repair techniques to optimize the outcomes of mitral valve repair in ischemic MR.

Authors+Show Affiliations

1 Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA ; 2 Columbia University, Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA.1 Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA ; 2 Columbia University, Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26904260

Citation

Mihos, Christos G., and Orlando Santana. "Mitral Valve Repair for Ischemic Mitral Regurgitation: Lessons From the Cardiothoracic Surgical Trials Network Randomized Study." Journal of Thoracic Disease, vol. 8, no. 1, 2016, pp. E94-9.
Mihos CG, Santana O. Mitral valve repair for ischemic mitral regurgitation: lessons from the Cardiothoracic Surgical Trials Network randomized study. J Thorac Dis. 2016;8(1):E94-9.
Mihos, C. G., & Santana, O. (2016). Mitral valve repair for ischemic mitral regurgitation: lessons from the Cardiothoracic Surgical Trials Network randomized study. Journal of Thoracic Disease, 8(1), pp. E94-9. doi:10.3978/j.issn.2072-1439.2016.01.27.
Mihos CG, Santana O. Mitral Valve Repair for Ischemic Mitral Regurgitation: Lessons From the Cardiothoracic Surgical Trials Network Randomized Study. J Thorac Dis. 2016;8(1):E94-9. PubMed PMID: 26904260.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mitral valve repair for ischemic mitral regurgitation: lessons from the Cardiothoracic Surgical Trials Network randomized study. AU - Mihos,Christos G, AU - Santana,Orlando, PY - 2016/2/24/entrez PY - 2016/2/24/pubmed PY - 2016/2/24/medline KW - Coronary artery disease KW - ischemic mitral regurgitation KW - mitral valve repair KW - mitral valve replacement KW - papillary muscle SP - E94 EP - 9 JF - Journal of thoracic disease JO - J Thorac Dis VL - 8 IS - 1 N2 - Approximately 30% to 50% of patients will develop ischemic mitral regurgitation (MR) after a myocardial infarction, which is a result of progressive left ventricular remodeling and dysfunction of the subvalvular apparatus, and portends a poor long-term prognosis. Surgical treatment is centered on mitral valve repair utilizing a restrictive annuloplasty, or valve replacement with preservation of the subvalvular apparatus. In the recent Cardiothoracic Surgical Trials Network (CSTN) study, patients with severe ischemic MR were randomized to mitral valve repair with a restrictive annuloplasty versus chordal-sparing valve replacement, and concomitant coronary artery bypass grafting, if indicated. At 2-year follow-up, mitral valve repair was associated with a significantly higher incidence of moderate or greater recurrent MR and heart failure, with no difference in the indices of left ventricular reverse remodeling, as compared with valve replacement. The current appraisal aims to provide insight into the CSTN trial results, and discusses the evidence supporting a pathophysiologic-guided repair strategy incorporating combined annuloplasty and subvalvular repair techniques to optimize the outcomes of mitral valve repair in ischemic MR. SN - 2072-1439 UR - https://www.unboundmedicine.com/medline/citation/26904260/Mitral_valve_repair_for_ischemic_mitral_regurgitation:_lessons_from_the_Cardiothoracic_Surgical_Trials_Network_randomized_study_ L2 - https://doi.org/10.3978/j.issn.2072-1439.2016.01.27 DB - PRIME DP - Unbound Medicine ER -