Management of mitral regurgitation in Marfan syndrome: Outcomes of valve repair versus replacement and comparison with myxomatous mitral valve disease

Meghana R K Helder, Hartzell V Schaff, Joseph A. Dearani, Zhuo Li, John M. Stulak, Rakesh M. Suri, Heidi M. Connolly

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives The study objective was to evaluate patients with Marfan syndrome and mitral valve regurgitation undergoing valve repair or replacement and to compare them with patients undergoing repair for myxomatous mitral valve disease. Methods We reviewed the medical records of consecutive patients with Marfan syndrome treated surgically between March 17, 1960, and September 12, 2011, for mitral regurgitation and performed a subanalysis of those with repairs compared with case-matched patients with myxomatous mitral valve disease who had repairs (March 14, 1995, to July 5, 2013). Results Of 61 consecutive patients, 40 underwent mitral repair and 21 underwent mitral replacement (mean [standard deviation] age, 40 [18] vs 31 [19] years; P =.09). Concomitant aortic surgery was performed to a similar extent (repair, 45% [18/40] vs replacement, 43% [9/21]; P =.87). Ten-year survival was significantly better in patients with Marfan syndrome with mitral repair than in those with replacement (80% vs 41%; P =.01). Mitral reintervention did not differ between mitral repair and replacement (cumulative risk of reoperation, 27% vs 15%; P =.64). In the matched cohort, 10-year survival after repair was similar for patients with Marfan syndrome and myxomatous mitral disease (84% vs 78%; P =.63), as was cumulative risk of reoperation (17% vs 12%; P =.61). Conclusions Patients with Marfan syndrome and mitral regurgitation have better survival with repair than with replacement. Survival and risk of reoperation for patients with Marfan syndrome were similar to those for patients with myxomatous mitral disease. These results support the use of mitral valve repair in patients with Marfan syndrome and moderate or more mitral regurgitation, including those having composite replacement of the aortic root.

Original languageEnglish (US)
Pages (from-to)1020-1024
Number of pages5
JournalJournal of Thoracic and Cardiovascular Surgery
Volume148
Issue number3
DOIs
StatePublished - 2014

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Marfan Syndrome
Mitral Valve Insufficiency
Mitral Valve
Reoperation
Survival
Medical Records

ASJC Scopus subject areas

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

Cite this

Management of mitral regurgitation in Marfan syndrome : Outcomes of valve repair versus replacement and comparison with myxomatous mitral valve disease. / Helder, Meghana R K; Schaff, Hartzell V; Dearani, Joseph A.; Li, Zhuo; Stulak, John M.; Suri, Rakesh M.; Connolly, Heidi M.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 148, No. 3, 2014, p. 1020-1024.

Research output: Contribution to journalArticle

Helder, Meghana R K ; Schaff, Hartzell V ; Dearani, Joseph A. ; Li, Zhuo ; Stulak, John M. ; Suri, Rakesh M. ; Connolly, Heidi M. / Management of mitral regurgitation in Marfan syndrome : Outcomes of valve repair versus replacement and comparison with myxomatous mitral valve disease. In: Journal of Thoracic and Cardiovascular Surgery. 2014 ; Vol. 148, No. 3. pp. 1020-1024.
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title = "Management of mitral regurgitation in Marfan syndrome: Outcomes of valve repair versus replacement and comparison with myxomatous mitral valve disease",
abstract = "Objectives The study objective was to evaluate patients with Marfan syndrome and mitral valve regurgitation undergoing valve repair or replacement and to compare them with patients undergoing repair for myxomatous mitral valve disease. Methods We reviewed the medical records of consecutive patients with Marfan syndrome treated surgically between March 17, 1960, and September 12, 2011, for mitral regurgitation and performed a subanalysis of those with repairs compared with case-matched patients with myxomatous mitral valve disease who had repairs (March 14, 1995, to July 5, 2013). Results Of 61 consecutive patients, 40 underwent mitral repair and 21 underwent mitral replacement (mean [standard deviation] age, 40 [18] vs 31 [19] years; P =.09). Concomitant aortic surgery was performed to a similar extent (repair, 45{\%} [18/40] vs replacement, 43{\%} [9/21]; P =.87). Ten-year survival was significantly better in patients with Marfan syndrome with mitral repair than in those with replacement (80{\%} vs 41{\%}; P =.01). Mitral reintervention did not differ between mitral repair and replacement (cumulative risk of reoperation, 27{\%} vs 15{\%}; P =.64). In the matched cohort, 10-year survival after repair was similar for patients with Marfan syndrome and myxomatous mitral disease (84{\%} vs 78{\%}; P =.63), as was cumulative risk of reoperation (17{\%} vs 12{\%}; P =.61). Conclusions Patients with Marfan syndrome and mitral regurgitation have better survival with repair than with replacement. Survival and risk of reoperation for patients with Marfan syndrome were similar to those for patients with myxomatous mitral disease. These results support the use of mitral valve repair in patients with Marfan syndrome and moderate or more mitral regurgitation, including those having composite replacement of the aortic root.",
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T1 - Management of mitral regurgitation in Marfan syndrome

T2 - Outcomes of valve repair versus replacement and comparison with myxomatous mitral valve disease

AU - Helder, Meghana R K

AU - Schaff, Hartzell V

AU - Dearani, Joseph A.

AU - Li, Zhuo

AU - Stulak, John M.

AU - Suri, Rakesh M.

AU - Connolly, Heidi M.

PY - 2014

Y1 - 2014

N2 - Objectives The study objective was to evaluate patients with Marfan syndrome and mitral valve regurgitation undergoing valve repair or replacement and to compare them with patients undergoing repair for myxomatous mitral valve disease. Methods We reviewed the medical records of consecutive patients with Marfan syndrome treated surgically between March 17, 1960, and September 12, 2011, for mitral regurgitation and performed a subanalysis of those with repairs compared with case-matched patients with myxomatous mitral valve disease who had repairs (March 14, 1995, to July 5, 2013). Results Of 61 consecutive patients, 40 underwent mitral repair and 21 underwent mitral replacement (mean [standard deviation] age, 40 [18] vs 31 [19] years; P =.09). Concomitant aortic surgery was performed to a similar extent (repair, 45% [18/40] vs replacement, 43% [9/21]; P =.87). Ten-year survival was significantly better in patients with Marfan syndrome with mitral repair than in those with replacement (80% vs 41%; P =.01). Mitral reintervention did not differ between mitral repair and replacement (cumulative risk of reoperation, 27% vs 15%; P =.64). In the matched cohort, 10-year survival after repair was similar for patients with Marfan syndrome and myxomatous mitral disease (84% vs 78%; P =.63), as was cumulative risk of reoperation (17% vs 12%; P =.61). Conclusions Patients with Marfan syndrome and mitral regurgitation have better survival with repair than with replacement. Survival and risk of reoperation for patients with Marfan syndrome were similar to those for patients with myxomatous mitral disease. These results support the use of mitral valve repair in patients with Marfan syndrome and moderate or more mitral regurgitation, including those having composite replacement of the aortic root.

AB - Objectives The study objective was to evaluate patients with Marfan syndrome and mitral valve regurgitation undergoing valve repair or replacement and to compare them with patients undergoing repair for myxomatous mitral valve disease. Methods We reviewed the medical records of consecutive patients with Marfan syndrome treated surgically between March 17, 1960, and September 12, 2011, for mitral regurgitation and performed a subanalysis of those with repairs compared with case-matched patients with myxomatous mitral valve disease who had repairs (March 14, 1995, to July 5, 2013). Results Of 61 consecutive patients, 40 underwent mitral repair and 21 underwent mitral replacement (mean [standard deviation] age, 40 [18] vs 31 [19] years; P =.09). Concomitant aortic surgery was performed to a similar extent (repair, 45% [18/40] vs replacement, 43% [9/21]; P =.87). Ten-year survival was significantly better in patients with Marfan syndrome with mitral repair than in those with replacement (80% vs 41%; P =.01). Mitral reintervention did not differ between mitral repair and replacement (cumulative risk of reoperation, 27% vs 15%; P =.64). In the matched cohort, 10-year survival after repair was similar for patients with Marfan syndrome and myxomatous mitral disease (84% vs 78%; P =.63), as was cumulative risk of reoperation (17% vs 12%; P =.61). Conclusions Patients with Marfan syndrome and mitral regurgitation have better survival with repair than with replacement. Survival and risk of reoperation for patients with Marfan syndrome were similar to those for patients with myxomatous mitral disease. These results support the use of mitral valve repair in patients with Marfan syndrome and moderate or more mitral regurgitation, including those having composite replacement of the aortic root.

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