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J Thorac Cardiovasc Surg 2001;122:1125-1141
© 2001 The American Association for Thoracic Surgery


Surgery for Acquired Cardiovascular Disease (ACD)

Is repair preferable to replacement for ischemic mitral regurgitation?

A. Marc Gillinov, MDa, Per Nils Wierup, MDa*, Eugene H. Blackstone, MDa,b, Ehab S. Bishay, MDa, Delos M. Cosgrove, MDa, Jennifer White, MSb, Bruce W. Lytle, MDa, Patrick M. McCarthy, MDb

From the Department of Thoracic and Cardiovascular Surgerya and the Department of Biostatistics and Epidemiology,b The Cleveland Clinic Foundation, Cleveland, Ohio.

Received for publication May 3, 2000. Revisions requested Sept 5, 2000; revisions received March 14, 2001. Accepted for publication April 11, 2001. Address for reprints: A. Marc Gillinov, MD, The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk F25, Cleveland, OH 44195 (E-mail: gillinom{at}ccf.org).

Abstract

Objective: This study was undertaken to compare mitral valve repair and replacement as treatments for ischemic mitral regurgitation.
Methods: From 1985 through 1997, a total of 482 patients with ischemic mitral regurgitation underwent either valve repair (n = 397) or valve replacement (n = 85). Patients more likely (P <= .01) to undergo repair had functional mitral regurgitation or coronary revascularization with an internal thoracic artery graft; those more likely to receive valve replacement were in higher New York Heart Association functional classes or underwent emergency operations. These factors were used for multivariable propensity matching. Risk factors for early and late death were identified by multivariable, multiphase hazard function analysis.
Results: Within the propensity-matched better-risk group, survivals after valve replacement were 81%, 56%, and 36% at 30 days, 1 year, and 5 years, but survivals after repair were 94%, 82%, and 58% at these intervals (P = .08). In contrast, within the poor-risk group, survivals after repair and replacement were similar (P = .4). Risk factors (P <= .01) included older age, higher functional class, greater wall motion abnormality, and renal dysfunction. Approximately 70% of patients were predicted to benefit from repair; the benefit lessened or was negated if an internal thoracic artery graft was not used, if a lateral wall motion abnormality was present, or if the mitral regurgitation jet pattern was complex. Freedom from repair failure at 5 years was 91%.
Conclusion: Late survival is poor after surgery for ischemic mitral regurgitation. Most patients with ischemic mitral regurgitation benefit from mitral valve repair. In the most complex, high-risk settings, survivals after repair and replacement are similar.


Related Article

Ischemic mitral regurgitation redux—To repair or to replace?
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J. Thorac. Cardiovasc. Surg. 2001 122: 1059-1062. [Extract] [Full Text] [PDF]



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J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 547 - 557.



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J. Thorac. Cardiovasc. Surg.Home page
Is a good perioperative echocardiographic result predictive of durability in ischemic mitral valve repair?
J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 565 - 573.e2.



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Ann. Thorac. Surg.Home page
M. A. Borger, A. Alam, P. M. Murphy, T. Doenst, and T. E. David
Chronic Ischemic Mitral Regurgitation: Repair, Replace or Rethink?
Ann. Thorac. Surg., March 1, 2006; 81(3): 1153 - 1161.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
R. C. Gorman and J. H. Gorman III
Why Should We Repair Ischemic Mitral Regurgitation?
Ann. Thorac. Surg., February 1, 2006; 81(2): 785 - 785.
[Full Text] [PDF]


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Ann. Thorac. Surg.Home page
J. J. Pilla, A. S. Blom, J. H. Gorman III, D. J. Brockman, J. Affuso, L. M. Parish, H. Sakamoto, B. M. Jackson, M. A. Acker, and R. C. Gorman
Early Postinfarction Ventricular Restraint Improves Borderzone Wall Thickening Dynamics During Remodeling
Ann. Thorac. Surg., December 1, 2005; 80(6): 2257 - 2262.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
E. A. Grossi, P. C. Saunders, Y. J. Woo, D. M. Gangahar, J. C. Laschinger, D. C. Kress, M. P. Caskey, C. F. Schwartz, and J. Wudel
Intraoperative Effects of the Coapsys Annuloplasty System in a Randomized Evaluation (RESTOR-MV) of Functional Ischemic Mitral Regurgitation
Ann. Thorac. Surg., November 1, 2005; 80(5): 1706 - 1711.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
A. S. Shah, S. A. Hannish, C. A. Milano, and D. D. Glower
Isolated Mitral Valve Repair in Patients With Depressed Left Ventricular Function
Ann. Thorac. Surg., October 1, 2005; 80(4): 1309 - 1314.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
A. M. Gillinov, E. H. Blackstone, J. Rajeswaran, M. Mawad, P. M. McCarthy, J. F. Sabik III, T. Shiota, B. W. Lytle, and D. M. Cosgrove
Ischemic Versus Degenerative Mitral Regurgitation: Does Etiology Affect Survival?
Ann. Thorac. Surg., September 1, 2005; 80(3): 811 - 819.
[Abstract] [Full Text] [PDF]


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CirculationHome page
F. Langer, F. Rodriguez, S. Ortiz, A. Cheng, T. C. Nguyen, M. K. Zasio, D. Liang, G. T. Daughters, N. B. Ingels, and D. C. Miller
Subvalvular Repair: The Key to Repairing Ischemic Mitral Regurgitation?
Circulation, August 30, 2005; 112(9_suppl): I-383 - I-389.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M. De Bonis, E. Lapenna, G. La Canna, E. Ficarra, M. Pagliaro, L. Torracca, F. Maisano, and O. Alfieri
Mitral Valve Repair for Functional Mitral Regurgitation in End-Stage Dilated Cardiomyopathy: Role of the "Edge-to-Edge" Technique
Circulation, August 30, 2005; 112(9_suppl): I-402 - I-408.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
D. R. Wong, A. K. Agnihotri, J. W. Hung, G. J. Vlahakes, C. W. Akins, A. D. Hilgenberg, J. C. Madsen, T. E. MacGillivray, M. H. Picard, and D. F. Torchiana
Long-Term Survival After Surgical Revascularization for Moderate Ischemic Mitral Regurgitation
Ann. Thorac. Surg., August 1, 2005; 80(2): 570 - 577.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
C. Alexiou, G. Doukas, M. Oc, B. Oc, L. Hadjinikolaou, and T. J. Spyt
Effect of Training in Mitral Valve Repair Surgery on the Early and Late Outcome
Ann. Thorac. Surg., July 1, 2005; 80(1): 183 - 188.
[Abstract] [Full Text] [PDF]


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CirculationHome page
W. A. Baumgartner, S. Burrows, P. J. del Nido, T. J. Gardner, S. Goldberg, R. C. Gorman, G. V. Letsou, A. Mascette, R. E. Michler, J. D. Puskas, et al.
Recommendations of the National Heart, Lung, and Blood Institute Working Group on Future Direction in Cardiac Surgery
Circulation, June 7, 2005; 111(22): 3007 - 3013.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
F. A. Tibayan, F. Rodriguez, F. Langer, M. K. Zasio, L. Bailey, D. Liang, G. T. Daughters, N. B. Ingels Jr, and D. C. Miller
Annular or subvalvular approach to chronic ischemic mitral regurgitation?
J. Thorac. Cardiovasc. Surg., June 1, 2005; 129(6): 1266 - 1275.
[Abstract] [Full Text] [PDF]


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CirculationHome page
P. C. Block
Percutaneous Mitral Valve Repair: Are They Changing the Guard?
Circulation, May 3, 2005; 111(17): 2154 - 2156.
[Full Text] [PDF]


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CirculationHome page
M. Daimon, T. Shiota, A. M. Gillinov, M. Hayase, M. Ruel, W. E. Cohn, S. J. Blacker, and J. R. Liddicoat
Percutaneous Mitral Valve Repair for Chronic Ischemic Mitral Regurgitation: A Real-Time Three-Dimensional Echocardiographic Study in an Ovine Model
Circulation, May 3, 2005; 111(17): 2183 - 2189.
[Abstract] [Full Text] [PDF]


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Eur. J. Cardiothorac. Surg.Home page
J. Braun, J. J. Bax, M. I.M. Versteegh, P. G. Voigt, E. R. Holman, R. J.M. Klautz, E. Boersma, and R. A.E. Dion
Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in ischemic mitral regurgitation
Eur. J. Cardiothorac. Surg., May 1, 2005; 27(5): 847 - 853.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
D. D. Glower, R. H. Tuttle, L. K. Shaw, R. E. Orozco, and J. S. Rankin
Patient survival characteristics after routine mitral valve repair for ischemic mitral regurgitation
J. Thorac. Cardiovasc. Surg., April 1, 2005; 129(4): 860 - 868.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
O. O. Al-Radi, P. C. Austin, J. V. Tu, T. E. David, and T. M. Yau
Mitral Repair Versus Replacement for Ischemic Mitral Regurgitation
Ann. Thorac. Surg., April 1, 2005; 79(4): 1260 - 1267.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
F. Maisano, A. Redaelli, M. Soncini, E. Votta, L. Arcobasso, and O. Alfieri
An Annular Prosthesis for the Treatment of Functional Mitral Regurgitation: Finite Element Model Analysis of a Dog Bone-Shaped Ring Prosthesis
Ann. Thorac. Surg., April 1, 2005; 79(4): 1268 - 1275.
[Abstract] [Full Text] [PDF]


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MMCTSHome page
A. M. Calafiore, M. Di Mauro, M. Contini, L. Weltert, and A. Bivona
Mitral valve repair in ischemic mitral regurgitation
MMCTS, March 24, 2005; 2005(0324): 521.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
Y. Enomoto, J. H. Gorman III, S. L. Moainie, B. M. Jackson, L. M. Parish, T. Plappert, A. Zeeshan, M. G. St. John-Sutton, and R. C. Gorman
Early Ventricular Restraint After Myocardial Infarction: Extent of the Wrap Determines the Outcome of Remodeling
Ann. Thorac. Surg., March 1, 2005; 79(3): 881 - 887.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
Y. Enomoto, J. H. Gorman III, S. L. Moainie, T. S. Guy, B. M. Jackson, L. M. Parish, T. Plappert, A. Zeeshan, M. G. St. John-Sutton, and R. C. Gorman
Surgical treatment of ischemic mitral regurgitation might not influence ventricular remodeling
J. Thorac. Cardiovasc. Surg., March 1, 2005; 129(3): 504 - 511.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
B-K. Lam, A. M. Gillinov, E. H. Blackstone, J. Rajeswaran, B. Yuh, S. K. Bhudia, P. M. McCarthy, and D. M. Cosgrove
Importance of Moderate Ischemic Mitral Regurgitation
Ann. Thorac. Surg., February 1, 2005; 79(2): 462 - 470.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
F. Maisano, Z. Ziskind, A. Grimaldi, A. Blasio, A. Caldarola, M. De Bonis, G. La Canna, and O. Alfieri
Selective reduction of the septolateral dimensions in functional mitral regurgitation by modified-shape ring annuloplasty
J. Thorac. Cardiovasc. Surg., February 1, 2005; 129(2): 472 - 474.
[Full Text] [PDF]


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J Am Coll CardiolHome page
F. Grigioni, D. Detaint, J.-F. Avierinos, C. Scott, J. Tajik, and M. Enriquez-Sarano
Contribution of ischemic mitral regurgitation to congestive heart failure after myocardial infarction
J. Am. Coll. Cardiol., January 18, 2005; 45(2): 260 - 267.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
E. C. McGee Jr, A. M. Gillinov, E. H. Blackstone, J. Rajeswaran, G. Cohen, F. Najam, T. Shiota, J. F. Sabik, B. W. Lytle, P. M. McCarthy, et al.
Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation
J. Thorac. Cardiovasc. Surg., December 1, 2004; 128(6): 916 - 924.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
R. M. Ahmad, A. M. Gillinov, P. M. McCarthy, E. H. Blackstone, C. Apperson-Hansen, J. X. Qin, D. Agler, T. Shiota, and D. M. Cosgrove
Annular Geometry and Motion in Human Ischemic Mitral Regurgitation: Novel Assessment With Three-Dimensional Echocardiography and Computer Reconstruction
Ann. Thorac. Surg., December 1, 2004; 78(6): 2063 - 2068.
[Abstract] [Full Text] [PDF]


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Eur. J. Cardiothorac. Surg.Home page
J. Jouan, M. Tapia, R. C. Cook, E. Lansac, and C. Acar
Ischemic mitral valve prolapse: mechanisms and implications for valve repair
Eur. J. Cardiothorac. Surg., December 1, 2004; 26(6): 1112 - 1117.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
H. R. Mallidi and M. P. Pelletier
Reply
J. Thorac. Cardiovasc. Surg., November 1, 2004; 128(5): 796 - 797.
[Full Text] [PDF]


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Eur J EchocardiogrHome page
E. Agricola, M. Oppizzi, F. Maisano, M. De Bonis, A. F.L. Schinkel, L. Torracca, A. Margonato, G. Melisurgo, and O. Alfieri
Echocardiographic classification of chronic ischemic mitral regurgitation caused by restricted motion according to tethering pattern
Eur J Echocardiogr, October 1, 2004; 5(5): 326 - 334.
[Abstract] [Full Text] [PDF]


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CirculationHome page
T. A. Timek, D. T. Lai, D. Liang, F. Tibayan, F. Langer, F. Rodriguez, G. T. Daughters, N. B. Ingels Jr, and D. C. Miller
Effects of Paracommissural Septal-Lateral Annular Cinching on Acute Ischemic Mitral Regurgitation
Circulation, September 14, 2004; 110(11_suppl_1): II-79 - II-84.
[Abstract] [Full Text] [PDF]


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CirculationHome page
F. Rodriguez, F. Langer, K. B. Harrington, F. A. Tibayan, M. K. Zasio, D. Liang, G. T. Daughters, N. B. Ingels, and D. C. Miller
Cutting Second-Order Chords Does Not Prevent Acute Ischemic Mitral Regurgitation
Circulation, September 14, 2004; 110(11_suppl_1): II-91 - II-97.
[Abstract] [Full Text] [PDF]




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