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J Thorac Cardiovasc Surg 2001;122:1107-1124
© 2001 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease (ACD) |
From the Division of Cardiothoracic Surgery, Department of Surgery, Division of Biostatistics, New York University School of Medicine, New York, NY.
Supported in part by The Foundation for Research in Cardiac Surgery and Cardiovascular Biology.
Received for publication May 27, 1999. Revisions requested July 26, 1999; revisions received April 24, 2001. Accepted for publication April 25, 2001. Address for reprints: Eugene A. Grossi, MD, NYU Medical Center, Suite 9-V, 530 First Ave, New York, NY 10028 (E-mail: grossi{at}cv.med.nyu.edu).
Abstract
Objective: This study reviews the 223 consecutive mitral valve operations for ischemic mitral insufficiency performed at New York University Medical Center between January 1976 and January 1996. The results for mitral valve reconstruction are compared with those for prosthetic mitral valve replacement.
Methods: From January 1976 to January 1996, 223 patients with ischemic mitral insufficiency underwent mitral valve reconstruction (n = 152) or prosthetic mitral valve replacement (n = 71). Coronary artery bypass grafting was performed in 89% of cases of mitral reconstruction and 80% of cases of prosthetic replacement. In the group undergoing reconstruction, 77% had valvuloplasty with a ring annuloplasty and 23% had valvuloplasty with suture annuloplasty. In the group undergoing prosthetic replacement, 82% of patients received bioprostheses and 18% received mechanical prostheses.
Results: Follow-up was 93% complete (median 14.6 mo, range 0-219 mo). Thirty-day mortality was 10% for mitral reconstruction and 20% for prosthetic replacement. The short-term mortality was higher among patients in New York Heart Association functional class IV than among those in classes I to III (odds ratio 5.75, confidence interval 1.25-26.5) and was reduced among patients with angina relative to those without angina (odds ratio 0.26, confidence interval 0.05-1.2). The 30-day death or complication rate was similarly elevated among patients in functional class IV (odds ratio 5.53; confidence interval 1.23-25.04). Patients with mitral valve reconstruction had lower short-term complication or death rates than did patients with prosthetic valve replacement (odds ratio 0.43, confidence interval 0.20-0.90). Eighty-two percent of patients with mitral valve reconstruction had no insufficiency or only trace insufficiency during the long-term follow-up period. Five-year complication-free survivals were 64% (confidence interval 54%-74%) for patients undergoing mitral valve reconstruction and 47% (confidence interval 33%-60%) for patients undergoing prosthetic valve replacement. Results of a series of statistical analyses suggest that outcome was linked primarily to preoperative New York Heart Association functional class.
Conclusions: Initial mortalities were similar among patients undergoing prosthetic replacement and valve reconstruction. Poor outcome was primarily related to preexisting comorbidities. Patients undergoing valve reconstruction had fewer valve-related complications. Valve reconstruction resulted in excellent durability and freedom from complications. These findings suggest that mitral valve reconstruction should be considered for appropriate patients with ischemic mitral insufficiency.
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J. Thorac. Cardiovasc. Surg. 2001 122: 1059-1062.
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B. H. Trichon, D. D. Glower, L. K. Shaw, C. H. Cabell, K. J. Anstrom, G. M. Felker, and C. M. O'Connor Survival After Coronary Revascularization, With and Without Mitral Valve Surgery, in Patients With Ischemic Mitral Regurgitation Circulation, September 9, 2003; 108(90101): II-103 - 110. [Abstract] [Full Text] [PDF]
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J. Braun, P.G. Voigt, M.I.M. Versteegh, and R.A.E. Dion Restrictive mitral annuloplasty in refractory cardiogenic shock with acute postinfarction mitral insufficiency and intact papillary muscle J. Thorac. Cardiovasc. Surg., July 1, 2003; 126(1): 284 - 286. [Full Text] [PDF]
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E. Lim, Z. A. Ali, C. W. Barlow, C. H. Jackson, A.-R. Hosseinpour, J. C. Halstead, J. B. Barlow, and F. C. Wells A simple model to predict coronary disease in patients undergoing operation for mitral regurgitation Ann. Thorac. Surg., June 1, 2003; 75(6): 1820 - 1825. [Abstract] [Full Text] [PDF]
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D. H. Adams and F. Filsoufi Another chapter in an enlarging book: Repair degenerative mitral valves J. Thorac. Cardiovasc. Surg., June 1, 2003; 125(6): 1197 - 1199. [Full Text] [PDF]
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Zoltan. A. Szalay, A. Civelek, S. Hohe, H.-P. Brunner-LaRocca, W.-P. Klovekorn, I. Knez, P. R. Vogt, and E. P. Bauer Mitral annuloplasty in patients with ischemic versus dilated cardiomyopathy Eur. J. Cardiothorac. Surg., April 1, 2003; 23(4): 567 - 572. [Abstract] [Full Text] [PDF]
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D. C. Miller Ischemic mitral regurgitation redux--to repair or to replace? J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(90030): S58 - 61. [Full Text] [PDF]
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R. C. Gorman, J. H. Gorman III, and L. H. Edmunds Jr. Ischemic Mitral Regurgitation Card. Surg. Adult, January 1, 2003; 2(2003): 751 - 769. [Full Text]
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J. I. Fann, N. B. Ingels Jr., and D. C. Miller Pathophysiology of Mitral Valve Disease Card. Surg. Adult, January 1, 2003; 2(2003): 901 - 931. [Full Text]
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P. Fundaro, M. Pocar, F. Donatelli, and A. Grossi Chronic ischemic mitral regurgitation: Types and subtypes J. Thorac. Cardiovasc. Surg., October 1, 2002; 124(4): 855 - 856. [Full Text] [PDF]
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A. M. Gillinov and E. H. Blackstone Reply J. Thorac. Cardiovasc. Surg., October 1, 2002; 124(4): 856 - 856. [Full Text] [PDF]
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G. L. Grunkemeier, N. Payne, R. Jin, and J. R. Handy Jr Propensity score analysis of stroke after off-pump coronary artery bypass grafting Ann. Thorac. Surg., August 1, 2002; 74(2): 301 - 305. [Full Text] [PDF]
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S. L. Moainie, T. S. Guy, J. H. Gorman III, T. Plappert, B. M. Jackson, M. G. St. John-Sutton, L. H. Edmunds Jr, and R. C. Gorman Infarct restraint attenuates remodeling and reduces chronic ischemic mitral regurgitation after postero-lateral infarction Ann. Thorac. Surg., August 1, 2002; 74(2): 444 - 449. [Abstract] [Full Text] [PDF]
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D. C. Miller Ischemic mitral regurgitation redux--To repair or to replace? J. Thorac. Cardiovasc. Surg., December 1, 2001; 122(6): 1059 - 1062. [Full Text] [PDF]
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