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Mid-term results of mitral valve repair for ischemic mitral regurgitation adjusted according to the degree of remodeling progression.
Gen Thorac Cardiovasc Surg 2018; 66(12):707-715GT

Abstract

OBJECTIVES

Mitral annuloplasty (MAP) for ischemic mitral regurgitation (IMR) with advanced remodeling is often associated with recurrent mitral regurgitation (MR). We performed surgeries adjusted according to the degree of remodeling; i.e., for advanced remodeling cases, we added subvalvular repair (SVR) to MAP. This study aimed to evaluate our experience with patients with IMR.

METHODS AND RESULTS

Thirty patients with IMR (MR grade ≥ 2) were retrospectively analyzed. We performed MAP with SVR for 13 patients (MAP + SVR group) and MAP alone for 17 patients (MAP group). The MAP + SVR group had significantly larger left ventricular dimension and tenting height than the MAP group. Four patients (two in each group) experienced recurrence of MR (MR grade ≥ 2), and the 3-year and 5-year freedom from recurrence of MR rates were 97% and 83%, respectively. Six patients (two in the MAP group and four in the MAP + SVR group) died of cardiac causes during follow-up, and the 3-year and 5-year freedom from cardiac-related death rates were 81% and 74%, respectively. There was no difference between the 2 groups regarding freedom from recurrent MR (p = 0.6) and freedom from cardiac-related death (p = 0.1). The preoperative left ventricular end-systolic dimension was a significant predictor of cardiac death in the multivariate analysis.

CONCLUSION

Mitral valve repair adjusted according to the degree of remodeling progression provided durable mitral competence; however, it remains unclear if such a strategy is related to a high probability of freedom from cardiac-related death.

Authors+Show Affiliations

Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Japan. koji_furukawa@med.miyazaki-u.ac.jp. Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki City, Miyazaki, 889-1692, Japan. koji_furukawa@med.miyazaki-u.ac.jp.Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Japan.Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki City, Miyazaki, 889-1692, Japan.Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Japan.Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki City, Miyazaki, 889-1692, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30145737

Citation

Furukawa, Koji, et al. "Mid-term Results of Mitral Valve Repair for Ischemic Mitral Regurgitation Adjusted According to the Degree of Remodeling Progression." General Thoracic and Cardiovascular Surgery, vol. 66, no. 12, 2018, pp. 707-715.
Furukawa K, Yano M, Nakamura E, et al. Mid-term results of mitral valve repair for ischemic mitral regurgitation adjusted according to the degree of remodeling progression. Gen Thorac Cardiovasc Surg. 2018;66(12):707-715.
Furukawa, K., Yano, M., Nakamura, E., Nishimura, M., & Nakamura, K. (2018). Mid-term results of mitral valve repair for ischemic mitral regurgitation adjusted according to the degree of remodeling progression. General Thoracic and Cardiovascular Surgery, 66(12), pp. 707-715. doi:10.1007/s11748-018-1000-4.
Furukawa K, et al. Mid-term Results of Mitral Valve Repair for Ischemic Mitral Regurgitation Adjusted According to the Degree of Remodeling Progression. Gen Thorac Cardiovasc Surg. 2018;66(12):707-715. PubMed PMID: 30145737.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mid-term results of mitral valve repair for ischemic mitral regurgitation adjusted according to the degree of remodeling progression. AU - Furukawa,Koji, AU - Yano,Mitsuhiro, AU - Nakamura,Eisaku, AU - Nishimura,Masanori, AU - Nakamura,Kunihide, Y1 - 2018/08/25/ PY - 2018/06/07/received PY - 2018/08/12/accepted PY - 2018/8/27/pubmed PY - 2019/1/9/medline PY - 2018/8/27/entrez KW - Ischemic mitral regurgitation KW - Mitral annuloplasty KW - Mitral valve repair KW - Subvalvular repair SP - 707 EP - 715 JF - General thoracic and cardiovascular surgery JO - Gen Thorac Cardiovasc Surg VL - 66 IS - 12 N2 - OBJECTIVES: Mitral annuloplasty (MAP) for ischemic mitral regurgitation (IMR) with advanced remodeling is often associated with recurrent mitral regurgitation (MR). We performed surgeries adjusted according to the degree of remodeling; i.e., for advanced remodeling cases, we added subvalvular repair (SVR) to MAP. This study aimed to evaluate our experience with patients with IMR. METHODS AND RESULTS: Thirty patients with IMR (MR grade ≥ 2) were retrospectively analyzed. We performed MAP with SVR for 13 patients (MAP + SVR group) and MAP alone for 17 patients (MAP group). The MAP + SVR group had significantly larger left ventricular dimension and tenting height than the MAP group. Four patients (two in each group) experienced recurrence of MR (MR grade ≥ 2), and the 3-year and 5-year freedom from recurrence of MR rates were 97% and 83%, respectively. Six patients (two in the MAP group and four in the MAP + SVR group) died of cardiac causes during follow-up, and the 3-year and 5-year freedom from cardiac-related death rates were 81% and 74%, respectively. There was no difference between the 2 groups regarding freedom from recurrent MR (p = 0.6) and freedom from cardiac-related death (p = 0.1). The preoperative left ventricular end-systolic dimension was a significant predictor of cardiac death in the multivariate analysis. CONCLUSION: Mitral valve repair adjusted according to the degree of remodeling progression provided durable mitral competence; however, it remains unclear if such a strategy is related to a high probability of freedom from cardiac-related death. SN - 1863-6713 UR - https://www.unboundmedicine.com/medline/citation/30145737/Mid_term_results_of_mitral_valve_repair_for_ischemic_mitral_regurgitation_adjusted_according_to_the_degree_of_remodeling_progression_ L2 - https://dx.doi.org/10.1007/s11748-018-1000-4 DB - PRIME DP - Unbound Medicine ER -