Meta-analysis of short-term and long-term survival following repair versus replacement for ischemic mitral regurgitation

Vassileva, Christina M.; Boley, Theresa; Markwell, Stephen; Hazelrigg, Stephen
March 2011
European Journal of Cardio-Thoracic Surgery;Mar2011, Vol. 39 Issue 3, p295
Academic Journal
Summary: The optimal surgical strategy for the management of ischemic mitral regurgitation (IMR) is still debated. The purpose of this study was to perform a meta-analysis summarizing the evidence favoring one technique over another (repair vs replacement). A search of the English literature in PubMed was performed using ‘ischemic mitral regurgitation’ and ‘repair or replacement or annuloplasty’ in the title/abstract field. Articles were excluded if they lacked a direct comparison of repair versus replacement, or used Teflon/pericardial strip or suture annuloplasty in >10% of the repairs. Nine articles were selected for the final analysis. All studies except one were relatively recent (2004–2009). The patient characteristics between treatment groups were similar across studies. All studies excluded patients with degenerative etiology and used a rigorous definition of IMR. Most patients had concomitant coronary artery bypass graft. In the patients with mitral valve replacement, at least the posterior and, in many cases, the entire subvalvular apparatus were preserved. Mean ejection fraction and proportion of patients with severe ventricular dysfunction were similar between the repair and replacement groups. The odds ratios for the studies, comparing replacement to repair, ranged from 0.884 to 17.241 for short-term mortality and the hazard ratios ranged from 0.677 to 3.205 for long-term mortality. There was a significantly increased likelihood of both short-term mortality (summary odds ratio 2.667 (95% confidence interval (CI) 1.859–3.817)) and long-term mortality (summary hazard ratio 1.352 (95% CI 1.131–1.618)) for the replacement group compared to the repair group. Based on the meta-analysis of the current relevant literature, mitral valve repair for IMR is associated with better short-term and long-term survival compared to mitral valve replacement. Our conclusion should be interpreted in the context of the inherent limitations of a meta-analysis of retrospective studies including heterogeneity of patient characteristics, which may have influenced the physician''s decision to perform mitral valve repair or replacement. In the absence of any published randomized studies, mitral procedure selection should be individualized.


Related Articles

  • Impact of ascending aortic wall thickness and atherosclerosis on the intermediate survival after coronary artery bypass surgery. Biancari, Fausto; Lahtinen, Jarmo; Heikkinen, Jouni // European Journal of Cardio-Thoracic Surgery;May2012, Vol. 41 Issue 5, pe94 

    OBJECTIVES We investigated the prognostic impact of atherosclerosis and wall thickness of the ascending aorta in patients undergoing coronary artery bypass grafting (CABG). METHODS A series of 781 patients who underwent CABG and in whom epiaortic ultrasound was performed to assess the status of...

  • "Mitochondrial remodeling" in coronary heart disease. Masao Saotome; Hajnóczky, György; Hideki Katoh; Hiroshi Satoh; Hideharu Hayashi // Research Reports in Clinical Cardiology;2014, Vol. 5, p111 

    Coronary heart disease is a major cause of morbidity and mortality in advanced countries. Despite remarkable developments and achievements in the field of coronary intervention, such as percutaneous catheter intervention and coronary bypass surgery, the mortality from coronary heart disease...

  • New-onset atrial fibrillation at discharge in patients after coronary artery bypass surgery: short- and long-term morbidity and mortality. Tulla, Harri; Hippeläinen, Mikko; Turpeinen, Anu; Pitkänen, Otto; Hartikainen, Juha // European Journal of Cardio-Thoracic Surgery;Nov2015, Vol. 48 Issue 5, p747 

    OBJECTIVES: Atrial fibrillation (AF) after coronary artery bypass surgery is often considered a non-harmful and self-terminating condition. We studied the mortality and morbidity in patients with new-onset AF (NOAF) present at the time of hospital discharge. METHODS: We conducted a retrospective...

  • An approach to mitral valve surgery by a T-shaped mini-sternotomy with functioning bilateral internal thoracic artery grafts. Yosuke Takahashi; Yasushi Tsutsumi; Osamu Monta; Yasuyuki Kato; Keitaro Kohshi; Tomohiko Sakamoto; Hirokazu Ohashi // Surgery Today;Oct2009, Vol. 39 Issue 10, p922 

    Abstract  We herein report successful surgical treatment of mitral valve regurgitation in a 49-year-old man. He was admitted to our hospital due to acute aggravation of dyspnea on effort. He had a surgical history of coronary artery bypass grafting with bilateral internal...

  • Re-operations for aortic allograft root failure: experience from a 21-year single-center prospective follow-up study Bekkers, Jos A.; Klieverik, Loes M.A.; Raap, Goris Bol; Takkenberg, Johanna J.M.; Bogers, Ad J.J.C. // European Journal of Cardio-Thoracic Surgery;Jul2011, Vol. 40 Issue 1, p35 

    Abstract: Objective: The study aims to report results of re-operations after aortic allograft root implantation. Methods: All consecutive patients in our prospective allograft database, who underwent aortic allograft root implantation, were selected for analysis, and additional information for...

  • Associations between valve repair and reduced operative mortality in 21 056 mitral/tricuspid double valve procedures†. Rankin, J. Scott; Thourani, Vinod H.; Suri, Rakesh M.; He, Xia; O'Brien, Sean M.; Vassileva, Christina M.; Shah, Ashish S.; Williams, Matthew // European Journal of Cardio-Thoracic Surgery;Sep2013, Vol. 44 Issue 3, p472 

    OBJECTIVES Repair of either the mitral (M) or tricuspid (T) valve in single valve surgery is associated with reduced operative mortality. It is unclear, however, how valve repair influences mortality in combined MT procedures. This topic was evaluated in the Society of Thoracic Surgeons...

  • The Foundation and Launch of the Melbourne Interventional Group: A Collaborative Interventional Cardiology Project Ajani, A.E.; Szto, G.; Duffy, S.J.; Eccleston, D.; Clark, D.J.; Lefkovits, J.; Chew, D.P.; Warren, R.; Black, A.; New, G.; Walton, A.; Lew, R.; Shaw, J.; Horrigan, M.; Sebastian, M.; Yan, B.P.; Brennan, A.; Meehan, A.; Reid, C.; Krum, H. // Heart, Lung & Circulation;Feb2006, Vol. 15 Issue 1, p44 

    The Melbourne Interventional Group (MIG) is a voluntary collaborative venture of interventional cardiologists practicing at 12 major public and private hospitals in Victoria, designed to record data pertaining to percutaneous coronary interventions (PCI) and perform long-term follow-up. The...

  • Excess mortality of schizophrenia:A meta-analysis. Brown, Steve // British Journal of Psychiatry;Dec97, Vol. 171, p502 

    Background This paper presents a structured review of the published information on the mortality of schizophrenia. Method A meta-analysis of the literature. Results Schizophrenia has a significantly increased mortality from natural and unnatural causes. Twenty-eight per cent of the excess...

  • The Impacts of Albuminuria and Low eGFR on the Risk of Cardiovascular Death, All-Cause Mortality, and Renal Events in Diabetic Patients: Meta-Analysis. Toyama, Tadashi; Furuichi, Kengo; Ninomiya, Toshiharu; Shimizu, Miho; Hara, Akinori; Iwata, Yasunori; Kaneko, Shuichi; Wada, Takashi // PLoS ONE;Aug2013, Vol. 8 Issue 8, p1 

    Background: Precise effects of albuminuria and low estimated glomerular filtration rate (eGFR) on cardiovascular mortality, all-cause mortality, and renal events in diabetic patients are uncertain. Materials and Methods: A systematic review was conducted of the literature through MEDLINE,...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics