Mitral valve repair or replacement for ischemic mitral regurgitation? the Italian Study on the Treatment of Ischemic Mitral Regurgitation (ISTIMIR)

Roberto Lorusso, Sandro Gelsomino, Enrico Vizzardi, Antonio D'Aloia, Giuseppe De Cicco, Fabiana Lucà, Orlando Parise, Gian Franco Gensini, Pierluigi Stefàno, Ugolino Livi, Igor Vendramin, Davide Pacini, Roberto Di Bartolomeo, Antonio Miceli, Egidio Varone, Mattia Glauber, Alessandro Parolari, Francesco Giuseppe Arlati, Francesco Alamanni, Filiberto SerrainoAttilio Renzulli, Antonio Messina, Giovanni Troise, Giovanni Mariscalco, Marzia Cottini, Cesare Beghi, Francesco Nicolini, Tiziano Gherli, Valentino Borghetti, Alessandro Pardini, Philippe Primo Caimmi, Ezio Micalizzi, Carlo Fino, Paolo Ferrazzi, Michele Di Mauro, Antonio Maria Calafiore

Research output: Contribution to journalArticle

Abstract

Objective: It is uncertain whether mitral valve replacement is really inferior to mitral valve repair for the treatment of chronic ischemic mitral regurgitation. This multicenter study aimed at providing a contribution to this issue. Methods: Of 1006 patients with chronic ischemic mitral regurgitation and impaired left ventricular function (ejection fraction <40%) operated on at 13 Italian institutions between 1996 and 2011, 298 (29.6%) underwent mitral valve replacement whereas 708 (70.4%) received mitral valve repair. Propensity scores were calculated by a nonparsimonious multivariable logistic regression, and 244 pairs of patients were matched successfully using calipers of width 0.2 standard deviation of the logit of the propensity scores. The postmatching median standardized difference was 0.024 (range, 0-0.037) and in none of the covariates did it exceed 10%. Results: Early deaths were 3.3% (n = 8) in mitral valve repair versus 5.3% (n = 13) in mitral valve replacement (P = .32). Eight-year survival was 81.6% ± 2.8% and 79.6% ± 4.8% (P = .42), respectively. Actual freedom from all-cause reoperation and valve-related reoperation were 64.3% ± 4.3% versus 80% ± 4.1%, and 71.3% ± 3.5% versus 85.5% ± 3.9 in mitral valve repair and mitral valve replacement, respectively (P <.001). Actual freedom from all valve-related complications was 68.3% ± 3.1% versus 69.9% ± 3.3% in mitral valve repair and mitral valve replacement, respectively (P = .78). Left ventricular function did not improved significantly, and it was comparable in the 2 groups postoperatively (36.9% vs 38.5%, P = .66). At competing regression analysis, mitral valve repair was a strong predictor of reoperation (hazard ratio, 2.84; P <.001). Conclusions: Mitral valve replacement is a suitable option for patients with chronic ischemic mitral regurgitation and impaired left ventricular function. It provides better results in terms of freedom from reoperation with comparable valve-related complication rates.

Original languageEnglish
Pages (from-to)128-139
Number of pages12
JournalJournal of Thoracic and Cardiovascular Surgery
Volume145
Issue number1
DOIs
Publication statusPublished - Jan 2013

ASJC Scopus subject areas

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

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