HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) CME: Take the activity for this article: Valve repair versus valve replacement... Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Eugene H. Blackstone Edward R. Nowicki Worawong Slisatkorn Ghannam Al-Dossari Douglas R. Johnston Kristopher M. George Joseph F. Sabik, III Lars G. Svensson Permission Requests Google Scholar Articles by Gillinov, A. M. Articles by Svensson, L. G. PubMed Articles by Gillinov, A. M. Articles by Svensson, L. G. Related Collections Valve disease

J Thorac Cardiovasc Surg 2008;135:885-893
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Valve repair versus valve replacement for degenerative mitral valve disease

^a Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
^b Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
^c Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio

Received for publication May 2, 2007; revisions received October 15, 2007; accepted for publication November 26, 2007.

^_* Address for reprints: A. Marc Gillinov, MD, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Avenue/F24, Cleveland, OH 44195. (Email: gillinom{at}ccf.org).

Objective: The study objective was to identify characteristics differentiating patients undergoing valve replacement versus valve repair for degenerative mitral valve disease and to use this information to compare survival and reoperation after each procedure.

Methods: From 1985 to 2005, 3286 patients underwent isolated primary operation for degenerative mitral valve disease. Valve repair was performed in 3051 patients (93%), and valve replacement was performed in 235 patients (7.2%). A propensity model and score developed for fair comparison of outcomes yielded 195 matched pairs.

Results: Patients undergoing replacement were older (70 ± 12 years vs 57 ± 13 years) and had more complex valvar pathology, symptoms, and left ventricular dysfunction. Thus, the characteristics of the propensity-matched patients undergoing repair more resembled those of the patients undergoing replacement (older, complex valvar pathology) than patients undergoing typical repair. Eight patients died in the hospital (0.26%) after repair and 5 patients (2.1%) died after replacement (P = .001). Unadjusted survival at 5, 10, and 15 years was 95%, 87%, and 68% after repair and 80%, 60%, and 44% after replacement, respectively (P < .0001); however, among propensity-matched patients, survival was similar (P = .8): 86% versus 83% at 5 years, 63% versus 62% at 10 years, and 43% versus 48% at 15 years. Freedom from reoperation among propensity-matched patients was 94% at 5 and 10 years after repair and 95% and 92% at 5 and 10 years after replacement, respectively (P = .6).

Conclusion: It is reasonable to perform valve repair in elderly patients with complex degenerative mitral valve pathology because it can eliminate the need for anticoagulation and risk of prosthesis-related complications. However, when valve pathology is so complex that repair is infeasible, this study demonstrates that valve replacement does not diminish long-term outcomes.