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 language | English (US) |
|---|---|
| Pages (from-to) | 344-353 |
| Number of pages | 10 |
| Journal | New England Journal of Medicine |
| Volume | 374 |
| Issue number | 4 |
| DOIs | |
| State | Published - Jan 28 2016 |
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ASJC Scopus subject areas
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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 journal › Article
}
TY - JOUR
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
AB - 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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U2 - 10.1056/NEJMoa1512913
DO - 10.1056/NEJMoa1512913
M3 - Article
VL - 374
SP - 344
EP - 353
JO - New England Journal of Medicine
JF - New England Journal of Medicine
SN - 0028-4793
IS - 4
ER -