Original articleAdult cardiacValve Repair Is Superior to Replacement in Most Patients With Coexisting Degenerative Mitral Valve and Coronary Artery Diseases
Section snippets
Patients
Classification of degenerative structural mitral valve disease was based on standard criteria [8], particular attention being paid to differentiating these patients from those having functional ischemic MR. From January 1, 1985, to January 1, 2011, 1,071 patients underwent primary mitral valve repair (n = 872, 81%) or replacement (n = 199, 19%) and CABG for combined degenerative mitral valve and coronary artery diseases (Tables 1 and 2). Patients undergoing concomitant tricuspid valve repair
Choice of Mitral Valve Procedure
Mitral valve repair rather than replacement increased over time (Fig 1), stabilizing at approximately 80%. Preoperatively, patients undergoing valve replacement rather than repair were more likely to be older and more symptomatic (Table 1 and Supplemental eTable 1). Their mitral valve pathology was less likely to be a flail leaflet, but rather prolapse with valve calcification, often including areas of leaflet restriction. Their concomitant coronary grafts were similar, but in the mitral
Key Findings
At our institution, mitral valve repair is preferred for patients with combined degenerative mitral valve and coronary artery diseases; those undergoing valve replacement were older and sicker, with more complex valve pathology including leaflet and annular calcification and leaflet restriction or fibrosis, which present particular challenges for repair. Mitral valve repair was associated with fewer postoperative adverse events, similar risk of reoperation albeit for different indications, and
References (16)
- et al.
2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines
J Am Coll Cardiol
(2014) - et al.
Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era
Ann Thorac Surg
(2006) - et al.
Is repair preferable to replacement for ischemic mitral regurgitation?
J Thorac Cardiovasc Surg
(2001) - et al.
Ischemic versus degenerative mitral regurgitation: does etiology affect survival?
Ann Thorac Surg
(2005) Demise of a vital resource
J Thorac Cardiovasc Surg
(2012)- et al.
A comparison of outcomes of mitral valve repair for degenerative disease with posterior, anterior, and bileaflet prolapse
J Thorac Cardiovasc Surg
(2005) - et al.
Durability of mitral valve repair for degenerative disease
J Thorac Cardiovasc Surg
(1998) - et al.
Valve repair versus valve replacement for degenerative mitral valve disease
J Thorac Cardiovasc Surg
(2008)
Cited by (22)
Quantitating Mitral Regurgitation in Clinical Trials: The Need for a Uniform Approach
2022, Annals of Thoracic SurgeryTrends in MitraClip, mitral valve repair, and mitral valve replacement from 2000 to 2016
2021, Journal of Thoracic and Cardiovascular SurgeryCurrent status of the treatment of degenerative mitral valve regurgitation
2021, Revista Portuguesa de CardiologiaCombined Degenerative Mitral Valve and Coronary Surgery: Early Outcomes and 10-Year Survival
2020, Annals of Thoracic SurgeryCitation Excerpt :The logistic regression model analysis did not identify DMV+CABG surgery as an independent predictor of mortality, while it confirmed that replacing the MV instead of repairing it is associated with worse health outcome. Others have already underlined this concept by showing that MV repair is the preferred option in these patients7 with a reduced incidence of complications and mortality rate.24 This study has some limitations.
Meta-Analysis Comparing Mitral Valve Repair Versus Replacement for Degenerative Mitral Regurgitation Across All Ages
2019, American Journal of CardiologyCitation Excerpt :When the latter subgroup analysis was performed by including only studies showing adjusted results, there was still no statistically significant difference in HR between the subgroups (p = 0.348; Figure 5A). The HR of reoperation could be extracted from 6 studies11,15-17,19,20 including 3,180 patients. A pooled analysis demonstrated that the risk of reoperation was significantly higher in the MVR group than in the MVr group (HR [95% CI] = 1.47 [1.09, 1.98], I2 = 0%, Figure 5B).