Optimal surgical management of severe ischemic mitral regurgitation: To repair or to replace?

Louis P. Perrault, Alan J. Moskowitz, Irving L. Kron, Michael A. Acker, Marissa A. Miller, Keith A. Horvath, Vinod H. Thourani, Michael Argenziano, David A. D'Alessandro, Eugene H. Blackstone, Claudia S. Moy, Joseph P. Mathew, Judy Hung, Timothy J. Gardner, Michael K. Parides

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background: Ischemic mitral regurgitation, a complication of myocardial infarction and coronary artery disease more generally, is associated with a high mortality rate and is estimated to affect 2.8 million Americans. With 1-year mortality rates as high as 40%, recent practice guidelines of professional societies recommend repair or replacement, but there remains a lack of conclusive evidence supporting either intervention. The choice between therapeutic options is characterized by the trade-off between reduced operative morbidity and mortality with repair versus a better long-term correction of mitral insufficiency with replacement. The long-term benefits of repair versus replacement remain unknown, which has led to significant variation in surgical practice. Methods and Results: This article describes the design of a prospective randomized clinical trial to evaluate the safety and effectiveness of mitral valve repair and replacement in patients with severe ischemic mitral regurgitation. This trial is being conducted as part of the Cardiothoracic Surgical Trials Network. This article addresses challenges in selecting a feasible primary end point, characterizing the target population (including the degree of mitral regurgitation) and analytical challenges in this high mortality disease. Conclusions: The article concludes by discussing the importance of information on functional status, survival, neurocognition, quality of life, and cardiac physiology in therapeutic decision making.

Original languageEnglish (US)
Pages (from-to)1396-1403
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume143
Issue number6
DOIs
StatePublished - Jun 2012

Fingerprint

Mitral Valve Insufficiency
Mortality
Health Services Needs and Demand
Mitral Valve
Practice Guidelines
Coronary Artery Disease
Decision Making
Randomized Controlled Trials
Myocardial Infarction
Quality of Life
Morbidity
Safety
Survival
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Optimal surgical management of severe ischemic mitral regurgitation : To repair or to replace? / Perrault, Louis P.; Moskowitz, Alan J.; Kron, Irving L.; Acker, Michael A.; Miller, Marissa A.; Horvath, Keith A.; Thourani, Vinod H.; Argenziano, Michael; D'Alessandro, David A.; Blackstone, Eugene H.; Moy, Claudia S.; Mathew, Joseph P.; Hung, Judy; Gardner, Timothy J.; Parides, Michael K.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 143, No. 6, 06.2012, p. 1396-1403.

Research output: Contribution to journalArticle

Perrault, LP, Moskowitz, AJ, Kron, IL, Acker, MA, Miller, MA, Horvath, KA, Thourani, VH, Argenziano, M, D'Alessandro, DA, Blackstone, EH, Moy, CS, Mathew, JP, Hung, J, Gardner, TJ & Parides, MK 2012, 'Optimal surgical management of severe ischemic mitral regurgitation: To repair or to replace?', Journal of Thoracic and Cardiovascular Surgery, vol. 143, no. 6, pp. 1396-1403. https://doi.org/10.1016/j.jtcvs.2011.05.030
Perrault, Louis P. ; Moskowitz, Alan J. ; Kron, Irving L. ; Acker, Michael A. ; Miller, Marissa A. ; Horvath, Keith A. ; Thourani, Vinod H. ; Argenziano, Michael ; D'Alessandro, David A. ; Blackstone, Eugene H. ; Moy, Claudia S. ; Mathew, Joseph P. ; Hung, Judy ; Gardner, Timothy J. ; Parides, Michael K. / Optimal surgical management of severe ischemic mitral regurgitation : To repair or to replace?. In: Journal of Thoracic and Cardiovascular Surgery. 2012 ; Vol. 143, No. 6. pp. 1396-1403.
@article{45dc5c16a9a548cbb6b3f2ecdf2e20e9,
title = "Optimal surgical management of severe ischemic mitral regurgitation: To repair or to replace?",
abstract = "Background: Ischemic mitral regurgitation, a complication of myocardial infarction and coronary artery disease more generally, is associated with a high mortality rate and is estimated to affect 2.8 million Americans. With 1-year mortality rates as high as 40{\%}, recent practice guidelines of professional societies recommend repair or replacement, but there remains a lack of conclusive evidence supporting either intervention. The choice between therapeutic options is characterized by the trade-off between reduced operative morbidity and mortality with repair versus a better long-term correction of mitral insufficiency with replacement. The long-term benefits of repair versus replacement remain unknown, which has led to significant variation in surgical practice. Methods and Results: This article describes the design of a prospective randomized clinical trial to evaluate the safety and effectiveness of mitral valve repair and replacement in patients with severe ischemic mitral regurgitation. This trial is being conducted as part of the Cardiothoracic Surgical Trials Network. This article addresses challenges in selecting a feasible primary end point, characterizing the target population (including the degree of mitral regurgitation) and analytical challenges in this high mortality disease. Conclusions: The article concludes by discussing the importance of information on functional status, survival, neurocognition, quality of life, and cardiac physiology in therapeutic decision making.",
author = "Perrault, {Louis P.} and Moskowitz, {Alan J.} and Kron, {Irving L.} and Acker, {Michael A.} and Miller, {Marissa A.} and Horvath, {Keith A.} and Thourani, {Vinod H.} and Michael Argenziano and D'Alessandro, {David A.} and Blackstone, {Eugene H.} and Moy, {Claudia S.} and Mathew, {Joseph P.} and Judy Hung and Gardner, {Timothy J.} and Parides, {Michael K.}",
year = "2012",
month = "6",
doi = "10.1016/j.jtcvs.2011.05.030",
language = "English (US)",
volume = "143",
pages = "1396--1403",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Optimal surgical management of severe ischemic mitral regurgitation

T2 - To repair or to replace?

AU - Perrault, Louis P.

AU - Moskowitz, Alan J.

AU - Kron, Irving L.

AU - Acker, Michael A.

AU - Miller, Marissa A.

AU - Horvath, Keith A.

AU - Thourani, Vinod H.

AU - Argenziano, Michael

AU - D'Alessandro, David A.

AU - Blackstone, Eugene H.

AU - Moy, Claudia S.

AU - Mathew, Joseph P.

AU - Hung, Judy

AU - Gardner, Timothy J.

AU - Parides, Michael K.

PY - 2012/6

Y1 - 2012/6

N2 - Background: Ischemic mitral regurgitation, a complication of myocardial infarction and coronary artery disease more generally, is associated with a high mortality rate and is estimated to affect 2.8 million Americans. With 1-year mortality rates as high as 40%, recent practice guidelines of professional societies recommend repair or replacement, but there remains a lack of conclusive evidence supporting either intervention. The choice between therapeutic options is characterized by the trade-off between reduced operative morbidity and mortality with repair versus a better long-term correction of mitral insufficiency with replacement. The long-term benefits of repair versus replacement remain unknown, which has led to significant variation in surgical practice. Methods and Results: This article describes the design of a prospective randomized clinical trial to evaluate the safety and effectiveness of mitral valve repair and replacement in patients with severe ischemic mitral regurgitation. This trial is being conducted as part of the Cardiothoracic Surgical Trials Network. This article addresses challenges in selecting a feasible primary end point, characterizing the target population (including the degree of mitral regurgitation) and analytical challenges in this high mortality disease. Conclusions: The article concludes by discussing the importance of information on functional status, survival, neurocognition, quality of life, and cardiac physiology in therapeutic decision making.

AB - Background: Ischemic mitral regurgitation, a complication of myocardial infarction and coronary artery disease more generally, is associated with a high mortality rate and is estimated to affect 2.8 million Americans. With 1-year mortality rates as high as 40%, recent practice guidelines of professional societies recommend repair or replacement, but there remains a lack of conclusive evidence supporting either intervention. The choice between therapeutic options is characterized by the trade-off between reduced operative morbidity and mortality with repair versus a better long-term correction of mitral insufficiency with replacement. The long-term benefits of repair versus replacement remain unknown, which has led to significant variation in surgical practice. Methods and Results: This article describes the design of a prospective randomized clinical trial to evaluate the safety and effectiveness of mitral valve repair and replacement in patients with severe ischemic mitral regurgitation. This trial is being conducted as part of the Cardiothoracic Surgical Trials Network. This article addresses challenges in selecting a feasible primary end point, characterizing the target population (including the degree of mitral regurgitation) and analytical challenges in this high mortality disease. Conclusions: The article concludes by discussing the importance of information on functional status, survival, neurocognition, quality of life, and cardiac physiology in therapeutic decision making.

UR - http://www.scopus.com/inward/record.url?scp=84861191812&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861191812&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2011.05.030

DO - 10.1016/j.jtcvs.2011.05.030

M3 - Article

C2 - 22054660

AN - SCOPUS:84861191812

VL - 143

SP - 1396

EP - 1403

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 6

ER -