TY - JOUR
T1 - Valve repair improves the outcome of surgery for mitral regurgitation
T2 - A multivariate analysis
AU - Enriquez-Sarano, Maurice
AU - Schaff, Hartzell V.
AU - Orszulak, Thomas A.
AU - Tajik, A. Jamil
AU - Bailey, Kent R.
AU - Frye, Robert L.
PY - 1995/2/15
Y1 - 1995/2/15
N2 - Background: Mitral valve repair has been suggested as providing a better postoperative outcome than valve replacement for mitral regurgitation, but this impression has been obscured by differences in baseline characteristics and has not been confirmed in multivariate analyses. Methods and Results: The outcomes in 195 patients with valve repair and 214 with replacement for organic mitral regurgitation were compared using multivariate analysis. All patients had preoperative echocardiographic assessment of left ventricular function. Before surgery, patients with valve repair were less symptomatic than those with replacement (42% in New York Heart Association functional class I or II versus 24%, respectively; P=.001), had less atrial fibrillation (41% versus 53%; P=.017), and had a better ejection fraction (63±9% versus 60±12%, P=.016). After valve repair, compared with valve replacement, overall survival at 10 years was 68±6% versus 52±4% (P=.0004), overall operative mortality was 2.6% versus 10.3% (P=.002), operative mortality in patients under age 75 was 1.3% versus 5.7% (P=.036), and late survival (in operative survivors) at 10 years was 69±6% versus 58±5% (P=.018). Late survival after valve repair was not different from expected survival. After surgery, ejection fraction decreased significantly in both groups but was higher after valve repair (P=.001). Multivariate analysis indicated an independent beneficial effect of valve repair on overall survival (hazard ratio, 0.39; P=.00001), operative mortality (odds ratio, 0.27; P=.026), late survival (hazard ratio, 0.44; P=.001), and postoperative ejection fraction (P=.001). Conclusions: Valve repair significantly improves postoperative outcome in patients with mitral regurgitation and should be the preferred mode of surgical correction. The low operative mortality is an incentive for early surgery before ventricular dysfunction occurs.
AB - Background: Mitral valve repair has been suggested as providing a better postoperative outcome than valve replacement for mitral regurgitation, but this impression has been obscured by differences in baseline characteristics and has not been confirmed in multivariate analyses. Methods and Results: The outcomes in 195 patients with valve repair and 214 with replacement for organic mitral regurgitation were compared using multivariate analysis. All patients had preoperative echocardiographic assessment of left ventricular function. Before surgery, patients with valve repair were less symptomatic than those with replacement (42% in New York Heart Association functional class I or II versus 24%, respectively; P=.001), had less atrial fibrillation (41% versus 53%; P=.017), and had a better ejection fraction (63±9% versus 60±12%, P=.016). After valve repair, compared with valve replacement, overall survival at 10 years was 68±6% versus 52±4% (P=.0004), overall operative mortality was 2.6% versus 10.3% (P=.002), operative mortality in patients under age 75 was 1.3% versus 5.7% (P=.036), and late survival (in operative survivors) at 10 years was 69±6% versus 58±5% (P=.018). Late survival after valve repair was not different from expected survival. After surgery, ejection fraction decreased significantly in both groups but was higher after valve repair (P=.001). Multivariate analysis indicated an independent beneficial effect of valve repair on overall survival (hazard ratio, 0.39; P=.00001), operative mortality (odds ratio, 0.27; P=.026), late survival (hazard ratio, 0.44; P=.001), and postoperative ejection fraction (P=.001). Conclusions: Valve repair significantly improves postoperative outcome in patients with mitral regurgitation and should be the preferred mode of surgical correction. The low operative mortality is an incentive for early surgery before ventricular dysfunction occurs.
KW - mitral valve
KW - myocardium
KW - prognosis
KW - surgery
KW - ventricles
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U2 - 10.1161/01.CIR.91.4.1022
DO - 10.1161/01.CIR.91.4.1022
M3 - Article
C2 - 7850937
AN - SCOPUS:0028911923
SN - 0009-7322
VL - 91
SP - 1022
EP - 1028
JO - Circulation
JF - Circulation
IS - 4
ER -