Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation

Daniel J. Goldstein, A. J. Moskowitz, A. C. Gelijns, G. Ailawadi, Michael K. Parides, L. P. Perrault, J. W. Hung, P. Voisine, F. Dagenais, A. M. Gillinov, V. Thourani, M. Argenziano, J. S. Gammie, M. Mack, P. Demers, P. Atluri, E. A. Rose, K. O'Sullivan, D. L. Williams, E. BagiellaRobert E. Michler, R. D. Weisel, M. A. Miller, N. L. Geller, W. C. Taddei-Peters, P. K. Smith, E. Moquete, J. R. Overbey, I. L. Kron, P. T. O'Gara, M. A. Acker

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: In a randomized trial comparing mitral-valve repair with mitral-valve replacement in patients with severe ischemic mitral regurgitation, we found no significant difference in the left ventricular end-systolic volume index (LVESVI), survival, or adverse events at 1 year after surgery. However, patients in the repair group had significantly more recurrences of moderate or severe mitral regurgitation. We now report the 2-year outcomes of this trial. METHODS: We randomly assigned 251 patients to mitral-valve repair or replacement. Patients were followed for 2 years, and clinical and echocardiographic outcomes were assessed. RESULTS: Among surviving patients, the mean (±SD) 2-year LVESVI was 52.6±27.7 ml per square meter of body-surface area with mitral-valve repair and 60.6±39.0 ml per square meter with mitral-valve replacement (mean changes from baseline, -9.0 ml per square meter and -6.5 ml per square meter, respectively). Two-year mortality was 19.0% in the repair group and 23.2% in the replacement group (hazard ratio in the repair group, 0.79; 95% confidence interval, 0.46 to 1.35; P=0.39). The rank-based assessment of LVESVI at 2 years (incorporating deaths) showed no significant between-group difference (z score=-1.32, P=0.19). The rate of recurrence of moderate or severe mitral regurgitation over 2 years was higher in the repair group than in the replacement group (58.8% vs. 3.8%, P

Original languageEnglish (US)
Pages (from-to)344-353
Number of pages10
JournalNew England Journal of Medicine
Volume374
Issue number4
DOIs
StatePublished - Jan 28 2016

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Mitral Valve Insufficiency
Mitral Valve
Stroke Volume
Recurrence
Body Surface Area
Confidence Intervals
Survival
Mortality

ASJC Scopus subject areas

  • Medicine(all)

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Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation. / Goldstein, Daniel J.; Moskowitz, A. J.; Gelijns, A. C.; Ailawadi, G.; Parides, Michael K.; Perrault, L. P.; Hung, J. W.; Voisine, P.; Dagenais, F.; Gillinov, A. M.; Thourani, V.; Argenziano, M.; Gammie, J. S.; Mack, M.; Demers, P.; Atluri, P.; Rose, E. A.; O'Sullivan, K.; Williams, D. L.; Bagiella, E.; Michler, Robert E.; Weisel, R. D.; Miller, M. A.; Geller, N. L.; Taddei-Peters, W. C.; Smith, P. K.; Moquete, E.; Overbey, J. R.; Kron, I. L.; O'Gara, P. T.; Acker, M. A.

In: New England Journal of Medicine, Vol. 374, No. 4, 28.01.2016, p. 344-353.

Research output: Contribution to journalArticle

Goldstein, DJ, Moskowitz, AJ, Gelijns, AC, Ailawadi, G, Parides, MK, Perrault, LP, Hung, JW, Voisine, P, Dagenais, F, Gillinov, AM, Thourani, V, Argenziano, M, Gammie, JS, Mack, M, Demers, P, Atluri, P, Rose, EA, O'Sullivan, K, Williams, DL, Bagiella, E, Michler, RE, Weisel, RD, Miller, MA, Geller, NL, Taddei-Peters, WC, Smith, PK, Moquete, E, Overbey, JR, Kron, IL, O'Gara, PT & Acker, MA 2016, 'Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation', New England Journal of Medicine, vol. 374, no. 4, pp. 344-353. https://doi.org/10.1056/NEJMoa1512913
Goldstein, Daniel J. ; Moskowitz, A. J. ; Gelijns, A. C. ; Ailawadi, G. ; Parides, Michael K. ; Perrault, L. P. ; Hung, J. W. ; Voisine, P. ; Dagenais, F. ; Gillinov, A. M. ; Thourani, V. ; Argenziano, M. ; Gammie, J. S. ; Mack, M. ; Demers, P. ; Atluri, P. ; Rose, E. A. ; O'Sullivan, K. ; Williams, D. L. ; Bagiella, E. ; Michler, Robert E. ; Weisel, R. D. ; Miller, M. A. ; Geller, N. L. ; Taddei-Peters, W. C. ; Smith, P. K. ; Moquete, E. ; Overbey, J. R. ; Kron, I. L. ; O'Gara, P. T. ; Acker, M. A. / Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation. In: New England Journal of Medicine. 2016 ; Vol. 374, No. 4. pp. 344-353.
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T1 - Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation

AU - Goldstein, Daniel J.

AU - Moskowitz, A. J.

AU - Gelijns, A. C.

AU - Ailawadi, G.

AU - Parides, Michael K.

AU - Perrault, L. P.

AU - Hung, J. W.

AU - Voisine, P.

AU - Dagenais, F.

AU - Gillinov, A. M.

AU - Thourani, V.

AU - Argenziano, M.

AU - Gammie, J. S.

AU - Mack, M.

AU - Demers, P.

AU - Atluri, P.

AU - Rose, E. A.

AU - O'Sullivan, K.

AU - Williams, D. L.

AU - Bagiella, E.

AU - Michler, Robert E.

AU - Weisel, R. D.

AU - Miller, M. A.

AU - Geller, N. L.

AU - Taddei-Peters, W. C.

AU - Smith, P. K.

AU - Moquete, E.

AU - Overbey, J. R.

AU - Kron, I. L.

AU - O'Gara, P. T.

AU - Acker, M. A.

PY - 2016/1/28

Y1 - 2016/1/28

N2 - BACKGROUND: In a randomized trial comparing mitral-valve repair with mitral-valve replacement in patients with severe ischemic mitral regurgitation, we found no significant difference in the left ventricular end-systolic volume index (LVESVI), survival, or adverse events at 1 year after surgery. However, patients in the repair group had significantly more recurrences of moderate or severe mitral regurgitation. We now report the 2-year outcomes of this trial. METHODS: We randomly assigned 251 patients to mitral-valve repair or replacement. Patients were followed for 2 years, and clinical and echocardiographic outcomes were assessed. RESULTS: Among surviving patients, the mean (±SD) 2-year LVESVI was 52.6±27.7 ml per square meter of body-surface area with mitral-valve repair and 60.6±39.0 ml per square meter with mitral-valve replacement (mean changes from baseline, -9.0 ml per square meter and -6.5 ml per square meter, respectively). Two-year mortality was 19.0% in the repair group and 23.2% in the replacement group (hazard ratio in the repair group, 0.79; 95% confidence interval, 0.46 to 1.35; P=0.39). The rank-based assessment of LVESVI at 2 years (incorporating deaths) showed no significant between-group difference (z score=-1.32, P=0.19). The rate of recurrence of moderate or severe mitral regurgitation over 2 years was higher in the repair group than in the replacement group (58.8% vs. 3.8%, P

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DO - 10.1056/NEJMoa1512913

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