PMID- 19073530
OWN - NLM
STAT- MEDLINE
DCOM- 20090415
LR  - 20081216
IS  - 1522-6662 (Electronic)
IS  - 1098-3511 (Linking)
VI  - 11
IP  - 6
DP  - 2008 Dec
TI  - Comparison of valve annuloplasty and replacement for ischemic mitral valve 
      incompetence.
PG  - E340-5
LID - 10.1532/HSF98.20081087 [doi]
AB  - OBJECTIVE: Mitral incompetence is a chronic sequela of myocardial infarction. It 
      is caused by apical displacement and tethering of the mitral valve leaflets after 
      myocardial infarction, resulting in incomplete coaptation. The consensus is for 
      mitral valve surgery in the presence of significant ischemic mitral regurgitation 
      (IMR). Previously, the only option was mitral valve replacement (MVR) with a 
      mechanical or tissue valve. The suboptimal results obtained prompted the 
      development of several methods of mitral valve repair. Today, the most commonly 
      used repair is undersized annuloplasty. METHODS: We conducted a retrospective 
      nonrandomized study of all patients who underwent operation for coronary artery 
      disease and IMR between 2000 and 2006. The surgeon chose the surgical method used 
      for the mitral valve procedure. The most commonly used procedures were 
      restrictive mitral valve annuloplasty (MVP) and MVR with a mechanical prosthesis. 
      We collected all pertinent preoperative, intraoperative, and early-postoperative 
      data. We followed up with phone interviews of the patients and their relatives 
      and with complete clinical and echocardiography examinations. RESULTS: We carried 
      out operations on 138 patients during the study period (MVR, 52 patients; MVP, 86 
      patients). The 2 groups had comparable demographic data and risk factors. The 2 
      groups were significantly different with respect to mean (+/-SD) New York Heart 
      Association (NYHA) class (MVP, 2.72 +/- 0.62; MVR, 2.48 +/- 0.70; P < .01) and 
      ejection fraction (MVP, 29.01% +/- 11.00%; MVR, 35.87% +/- 11.00%; P </= .01). 
      The 30-day mortality rates for the MVR and MVP groups were significantly 
      different (9.61% and 5.81%, respectively; P < .01). Our follow-up included 83% of 
      the patients and continued for up to 84 months. The 2 groups showed no 
      significant difference in mortality by the end of follow-up; however, the MVR 
      patients had a better ejection fraction (37.79% versus 29.86%) and NYHA 
      functional class (1.88 +/- 0.498 versus 2.36 +/- 0.564; P < .01). CONCLUSION: 
      Correcting chronic IMR with either repair or replacement produces a good mid-term 
      survival rate (approximately 75%) for survivors in NYHA classes I and II. In our 
      study, mortality rates for the MVP and MVR groups were similar, even though the 
      repair group had a lower mean ejection fraction and a higher NYHA class before 
      and after the operation. We therefore conclude that repair is superior to 
      replacement in treating ischemic mitral insufficiency. A prospective randomized 
      study is needed to better compare these 2 approaches.
FAU - Micovic, Slobodan
AU  - Micovic S
AD  - Cardiac Surgery Department and Echocardiography Cabinet, Cardiology Department, 
      Cardiovascular Institute Dedinje, Belgrade, Serbia. micko2006@yahoo.com
FAU - Milacic, Petar
AU  - Milacic P
FAU - Otasevic, Petar
AU  - Otasevic P
FAU - Tasic, Nebojsa
AU  - Tasic N
FAU - Boskovic, Srdjan
AU  - Boskovic S
FAU - Nezic, D
AU  - Nezic D
FAU - Djukanovic, B
AU  - Djukanovic B
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Heart Surg Forum
JT  - The heart surgery forum
JID - 100891112
SB  - IM
MH  - Cardiovascular Surgical Procedures/*mortality
MH  - Comorbidity
MH  - Female
MH  - Heart Valve Prosthesis/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve Insufficiency/*mortality/*surgery
MH  - Myocardial Ischemia/*mortality/*surgery
MH  - Retrospective Studies
MH  - Risk Assessment/*methods
MH  - Risk Factors
MH  - Serbia/epidemiology
MH  - Survival Analysis
MH  - Survival Rate
MH  - Treatment Outcome
EDAT- 2008/12/17 09:00
MHDA- 2009/04/16 09:00
CRDT- 2008/12/17 09:00
PHST- 2008/12/17 09:00 [entrez]
PHST- 2008/12/17 09:00 [pubmed]
PHST- 2009/04/16 09:00 [medline]
AID - MJR25924028H4422 [pii]
AID - 10.1532/HSF98.20081087 [doi]
PST - ppublish
SO  - Heart Surg Forum. 2008 Dec;11(6):E340-5. doi: 10.1532/HSF98.20081087.