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 language | English |
|---|---|
| Pages (from-to) | 128-139 |
| Number of pages | 12 |
| Journal | Journal of Thoracic and Cardiovascular Surgery |
| Volume | 145 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jan 2013 |
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ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Surgery
- Pulmonary and Respiratory Medicine
Cite this
Mitral valve repair or replacement for ischemic mitral regurgitation? the Italian Study on the Treatment of Ischemic Mitral Regurgitation (ISTIMIR). / Lorusso, Roberto; Gelsomino, Sandro; Vizzardi, Enrico; D'Aloia, Antonio; De Cicco, Giuseppe; Lucà, Fabiana; Parise, Orlando; Gensini, Gian Franco; Stefàno, Pierluigi; Livi, Ugolino; Vendramin, Igor; Pacini, Davide; Di Bartolomeo, Roberto; Miceli, Antonio; Varone, Egidio; Glauber, Mattia; Parolari, Alessandro; Giuseppe Arlati, Francesco; Alamanni, Francesco; Serraino, Filiberto; Renzulli, Attilio; Messina, Antonio; Troise, Giovanni; Mariscalco, Giovanni; Cottini, Marzia; Beghi, Cesare; Nicolini, Francesco; Gherli, Tiziano; Borghetti, Valentino; Pardini, Alessandro; Caimmi, Philippe Primo; Micalizzi, Ezio; Fino, Carlo; Ferrazzi, Paolo; Di Mauro, Michele; Calafiore, Antonio Maria.
In: Journal of Thoracic and Cardiovascular Surgery, Vol. 145, No. 1, 01.2013, p. 128-139.Research output: Contribution to journal › Article
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TY - JOUR
T1 - Mitral valve repair or replacement for ischemic mitral regurgitation? the Italian Study on the Treatment of Ischemic Mitral Regurgitation (ISTIMIR)
AU - Lorusso, Roberto
AU - Gelsomino, Sandro
AU - Vizzardi, Enrico
AU - D'Aloia, Antonio
AU - De Cicco, Giuseppe
AU - Lucà, Fabiana
AU - Parise, Orlando
AU - Gensini, Gian Franco
AU - Stefàno, Pierluigi
AU - Livi, Ugolino
AU - Vendramin, Igor
AU - Pacini, Davide
AU - Di Bartolomeo, Roberto
AU - Miceli, Antonio
AU - Varone, Egidio
AU - Glauber, Mattia
AU - Parolari, Alessandro
AU - Giuseppe Arlati, Francesco
AU - Alamanni, Francesco
AU - Serraino, Filiberto
AU - Renzulli, Attilio
AU - Messina, Antonio
AU - Troise, Giovanni
AU - Mariscalco, Giovanni
AU - Cottini, Marzia
AU - Beghi, Cesare
AU - Nicolini, Francesco
AU - Gherli, Tiziano
AU - Borghetti, Valentino
AU - Pardini, Alessandro
AU - Caimmi, Philippe Primo
AU - Micalizzi, Ezio
AU - Fino, Carlo
AU - Ferrazzi, Paolo
AU - Di Mauro, Michele
AU - Calafiore, Antonio Maria
PY - 2013/1
Y1 - 2013/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84871210338&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84871210338&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2012.09.042
DO - 10.1016/j.jtcvs.2012.09.042
M3 - Article
VL - 145
SP - 128
EP - 139
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
SN - 0022-5223
IS - 1
ER -