Is mitral valve repair superior to replacement for chronic ischemic mitral regurgitation with left ventricular dysfunction?

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• 作者：Zhibing Qiu (1)
  Xin Chen (1)
  Ming Xu (1)
  Yingshuo Jiang (1)
  Liqiong Xiao (1)
  LeLe Liu (1)
  Liming Wang (1)
  
• 刊名：Journal of Cardiothoracic Surgery
• 出版年：2010
• 出版时间：December 2010
• 年：2010
• 卷：5
• 期：1
• 全文大小：593KB
• 参考文献：1. Grossi EA, Goldberg JD, LaPietra A, Ye X, Zakow P, Sussman M, / et al.: Ischemic mitral valve reconstruction and replacement: Comparison of long-term survival and complications. / The Journal of Thoracic and Cardiovascular Surgery 2001, 22: 1107鈥?124. CrossRef
  2. Gillinov AM, Wierup PN, Blackstone EH, Bishay ES, Cosgrove DM, White J, / et al.: Is repair preferable to replacement for ischemic mitral regurgitation? / J Thorac Cardiovasc Surg 2001, 122: 1125鈥?141. CrossRef
  3. Thourani VH, Weintraub WS, Guyton RA, Jones EL, Williams WH, Elkabbani S, / et al.: Outcome and long term survival for patients undergoing mitral valve repair versus replacement. Effect of age and concomitant coronary artery bypass grafting. / Circulation 2003, 108: 298鈥?04. CrossRef
  4. Shah AS, Hannish SA, Milano CA, Glower DD: Isolated Mitral Valve Repair in Patients With Depressed Left Ventricular Function. / Ann Thorac Surg 2005, 80: 1309鈥?314. CrossRef
  5. Aronson D, Goldsher N, Zukermann R, Kapeliovich M, Lessick J, Mutlak D, / et al.: Ischemic mitral regurgitation and risk of heart failure after myocardial infarction. / Arch Intern Med 2006, 166: 2362鈥?36 8. CrossRef
  6. Carpentier A: Cardiac valve surgery--the "French correction". / J Thorac Cardiovasc Surg 1983, 86: 323鈥?37.
  7. Kwan J, Shiota T, Agler DA, Popovi膰 ZB, Qin JX, Gillinov MA, / et al.: Geometric differences of the mitral apparatus between ischemic and dilated cardiomyopathy with significant mitral regurgitation real-time three-dimensional echocardiography study. / Circulation 2003, 107: 1135鈥?140. CrossRef
  8. Helmecke F, Nanda NC, Hsiung MC, Soto B, Adey CK, Goyal RG, / et al.: Color Doppler assessment of mitral regurgitation with orthogonal planes. / Circulation 1987, 75: 175鈥?83.
  9. Akar AR, Doukas G, Szafranek A, Alexiou C, Boehm MC, Chin D, / et al.: Mitral valve repair and revascularization for ischemic mitral regurgitation: predictors of operative mortality and survival. / J Heart Valve Dis 2002, 11: 793鈥?00.
  10. Bolling S, Smolens IA, Pagani FD: Surgical alternatives for heart failure. / J Heart Lung Transplant 2001, 20: 729鈥?33. CrossRef
  11. Romano MA, Bolling SF: Update on mitral repair in dilated cardiomyopathy. / J Card Surg 2004, 19: 396鈥?00. CrossRef
  12. Kouris N, Ikonomidis I, Kontoqianni D, Smith P, Nihoyannopoulos P: Mitral valve repair versus replacement for isolated non-ischemic mitral regurgitation in patients with preoperative left ventricular dysfunction. A long-term follow-up echocardiography study. / Eur J Echocardiography 2005, 6: 435鈥?42. CrossRef
  13. Margo W, Obriot P: Mitral valve repair. / Aorn Journal 2007, 85: 152鈥?66. CrossRef
  14. Czer LS, Soukiasian HJ, De Robertis M, Magliato KE, Blanche C, / et al.: Ischemic Mitral Regurgitation: Revascularization Alone Versus Revascularization and Mitral Valve Repair. / Ann Thorac Surg 2005, 79: 1895鈥?901. CrossRef
  15. Braun J, van de Veire NR, Klautz RJ, Versteegh MI, Holman ER, Westenberg JJ, / et al.: Restrictive mitral annuloplasty cures ischemic mitral egurgitation and heart failure. / Ann Thorac Surg 2008, 85: 430鈥?36. CrossRef
  16. Calafiore AM, Di Mauro M, Gallina S, Di Giammarco G, Iac貌 AL, Teodori G, / et al.: Mitral valve surgery for chronic ischemic mitral regurgitation. / Ann Thorac Surg 2004, 77: 1989鈥?997. CrossRef
  17. Christenson JT, Licker M, Kalangos A: The role of intra-aortic counterpulsation in high risk OPCAB surgery: a prospective randomized study. / J Card Surg 2003, 18: 286鈥?94. CrossRef
  18. Suzuki T, Okabe M, Handa M, Yasuda F, Miyake Y: Usefulness of preoperative intraaortic balloon pump therapy during off-pump coronary artery bypass grafting in high-risk patients. / Ann Thorac Surg 2004, 77: 2056鈥?059. CrossRef
  19. Borger MA, Alam A, Murphy PM, Doenst T, David TE: Chronic ischemic mitral regurgitation: repair, replace or rethink? / Ann Thorac Surg 2006, 81: 1153鈥?161. CrossRef
  20. Lamas GA, Mitchell GF, Flaker GC, Smith SC Jr, Gersh BJ, Basta L, / et al.: Clinical significance of mitral regurgitation after acute myocardial infarction. Survival and Ventricular Enlargement Investigators. / Circulation 1997, 96: 827鈥?33.
  21. Micovic S, Milacic P, Otasevic P, Tasic N, Boskovic S, Nezic D, / et al.: Comparison of valve annuloplasty and replacement for ischemic mitral valve incompetence. / Heart Surg Forum 2008, 11: E340鈥?45. CrossRef
  22. Jokinen JJ, Hippel盲inen MJ, Pitk盲nen OA, Hartikainen JE: Mitral valve replacement versus repair: propensity-adjusted survival and quality-of-life analysis. / Ann Thorac Surg 2007, 84: 451鈥?58. CrossRef
  23. McGee EC, Gillinov AM, Blackstone EH, Rajeswaran J, Cohen G, Najam F, / et al.: Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation. / J Thorac Cardiovasc Surg 2004, 128: 916鈥?24.
  24. Braun J, Bax JJ, Versteegh MI, Voigt PG, Holman ER, Klautz RJ, / et al.: Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in ischemic mitral regurgitation. / Eur J Cardiothorac Surg 2005, 27: 847鈥?53. CrossRef
  25. Bax JJ, Braun J, Somer ST, Klautz R, Holman ER, Versteegh MI, / et al.: Restrictive annuloplasty and coronary revascularization in ischemic mitral regurgitation results in reverse left ventricular remodeling. / Circulation 2004, 110: 103鈥?08.
  26. Thourani VH, Weintraub WS, Guyton RA, Jones EL, Williams WH, Elkabbani S, / et al.: Outcome and long term survival for patients undergoing mitral valve repair versus replacement. Effect of age and concomitant coronary artery bypass grafting. / Circulation 2003, 108: 298鈥?04. CrossRef
  27. Suri RM, Schaff HV, Dearani JA, Sundt TM, Daly RC, Mullany CJ, / et al.: Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. / Ann Thorac Surg 2006, 82: 819鈥?26. CrossRef
  28. Rukosujew A, Klotz S, Welp H, Bruch C, Ghezelbash F, Schmidt C, / et al.: Surgery of secondary mitral insufficiency in patients with impaired left ventricular function. / J Cardiothorac Surg 2009, 17: 36鈥?0. CrossRef
  29. Al-Radi OO, Austin PC, Tu JV, David TE, Yau TM: Mitral repair versus replacement for ischemic mitral regurgitation. / Ann Thorac Surg 2005, 79: 1260鈥?267. CrossRef
  
• 作者单位：Zhibing Qiu (1)
  Xin Chen (1)
  Ming Xu (1)
  Yingshuo Jiang (1)
  Liqiong Xiao (1)
  LeLe Liu (1)
  Liming Wang (1)
  
  1. Department of Cardiothoracic Surgery, Nanjing First Hospital affiliated to Nanjing Medical University, Nanjing Heart Institute, Nanjing, China
  

文摘

Background This study was undertaken to compare mitral valve repair and replacement as treatments for ischemic mitral regurgitation (IMR) with left ventricular dysfunction (LVD). Specifically, we sought to determine whether the choice of mitral valve procedure affected survival, and discover which patients were predicted to benefit from mitral valve repair and which from replacement. Methods A total of 218 consecutive patients underwent either mitral valve repair (MVP, n = 112) or mitral valve replacement (MVR, n = 106). We retrospectively reviewed the clinical material, operation methods, echocardiography check during operation and follow-up. Patients details and follow-up outcomes were compared using multivariate and Kaplan-Meier analyses. Results No statistical difference was found between the two groups in term of intraoperative data. Early mortality was 3.2% (MVP 2.7% and MVR 3.8%). At discharge, Left ventricular end-systolic and end-diastolic diameter and left ventricular ejection fraction (LVEF) were improved more in the MVP group than MVR group (P < 0.05), however, in follow-up no statistically significant difference was observed between the MVR and MVP group (P > 0.05). Follow-up mitral regurgitation grade was significantly improved in the MVR group compared with the MVP group (P < 0.05). The Kaplan-Meier survival estimates at 1, 3, and 5 years were simlar between MVP and MVR group. Logistic regression revealed poor survival was associated with old age(#75), preoperative renal insufficiency and low left ventricular ejection fraction (< 30%). Conclusion Mitral valve repair is the procedure of choice in the majority of patients having surgery for severe ischemic mitral regurgitation with left ventricular dysfunction. Early results of MVP treatment seem to be satisfactory, but several lines of data indicate that mitral valve repair provided less long-term benefit than mitral valve replacement in the LVD patients.