TY - JOUR
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.
N1 - Funding Information:
Disclosures: Rakesh M. Suri is the Principal Investigator of the PERCEVAL Trial with patent applications and is the Co-principal Investigator of the COAPT Trial (Abbott), and receives grant support from St. Jude, Sorin, and Edwards. All other authors have nothing to disclose with regard to commercial support.
PY - 2014/9
Y1 - 2014/9
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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U2 - 10.1016/j.jtcvs.2014.06.046
DO - 10.1016/j.jtcvs.2014.06.046
M3 - Article
C2 - 25129593
AN - SCOPUS:84908545579
SN - 0022-5223
VL - 148
SP - 1020
EP - 1024
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 3
ER -