Valve repair improves the outcome of surgery for mitral regurgitation: A multivariate analysis

Maurice E Sarano, Hartzell V Schaff, T. A. Orszulak, A. J. Tajik, Kent R Bailey, R. L. Frye

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586 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1022-1028
Number of pages7
JournalCirculation
Volume91
Issue number4
StatePublished - 1995

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Mitral Valve Insufficiency
Multivariate Analysis
Survival
Mortality
Ventricular Dysfunction
Mitral Valve
Left Ventricular Function
Atrial Fibrillation
Survivors
Motivation
Odds Ratio

Keywords

  • mitral valve
  • myocardium
  • prognosis
  • surgery
  • ventricles

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Valve repair improves the outcome of surgery for mitral regurgitation : A multivariate analysis. / Sarano, Maurice E; Schaff, Hartzell V; Orszulak, T. A.; Tajik, A. J.; Bailey, Kent R; Frye, R. L.

In: Circulation, Vol. 91, No. 4, 1995, p. 1022-1028.

Research output: Contribution to journalArticle

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abstract = "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.",
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T1 - Valve repair improves the outcome of surgery for mitral regurgitation

T2 - A multivariate analysis

AU - Sarano, Maurice E

AU - Schaff, Hartzell V

AU - Orszulak, T. A.

AU - Tajik, A. J.

AU - Bailey, Kent R

AU - Frye, R. L.

PY - 1995

Y1 - 1995

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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