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 Serraino & 16 others Attilio 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

67 Citations (Scopus)

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

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Mitral Valve Insufficiency
Mitral Valve
Reoperation
Therapeutics
Left Ventricular Function
Propensity Score
Stroke Volume
Multicenter Studies
Logistic Models
Regression Analysis

ASJC Scopus subject areas

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

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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 journalArticle

Lorusso, R, Gelsomino, S, Vizzardi, E, D'Aloia, A, De Cicco, G, Lucà, F, Parise, O, Gensini, GF, Stefàno, P, Livi, U, Vendramin, I, Pacini, D, Di Bartolomeo, R, Miceli, A, Varone, E, Glauber, M, Parolari, A, Giuseppe Arlati, F, Alamanni, F, Serraino, F, Renzulli, A, Messina, A, Troise, G, Mariscalco, G, Cottini, M, Beghi, C, Nicolini, F, Gherli, T, Borghetti, V, Pardini, A, Caimmi, PP, Micalizzi, E, Fino, C, Ferrazzi, P, Di Mauro, M & Calafiore, AM 2013, 'Mitral valve repair or replacement for ischemic mitral regurgitation? the Italian Study on the Treatment of Ischemic Mitral Regurgitation (ISTIMIR)', Journal of Thoracic and Cardiovascular Surgery, vol. 145, no. 1, pp. 128-139. https://doi.org/10.1016/j.jtcvs.2012.09.042
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. / Mitral valve repair or replacement for ischemic mitral regurgitation? the Italian Study on the Treatment of Ischemic Mitral Regurgitation (ISTIMIR). In: Journal of Thoracic and Cardiovascular Surgery. 2013 ; Vol. 145, No. 1. pp. 128-139.
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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.",
author = "Roberto Lorusso and Sandro Gelsomino and Enrico Vizzardi and Antonio D'Aloia and {De Cicco}, Giuseppe and Fabiana Luc{\`a} and Orlando Parise and Gensini, {Gian Franco} and Pierluigi Stef{\`a}no and Ugolino Livi and Igor Vendramin and Davide Pacini and {Di Bartolomeo}, Roberto and Antonio Miceli and Egidio Varone and Mattia Glauber and Alessandro Parolari and {Giuseppe Arlati}, Francesco and Francesco Alamanni and Filiberto Serraino and Attilio Renzulli and Antonio Messina and Giovanni Troise and Giovanni Mariscalco and Marzia Cottini and Cesare Beghi and Francesco Nicolini and Tiziano Gherli and Valentino Borghetti and Alessandro Pardini and Caimmi, {Philippe Primo} and Ezio Micalizzi and Carlo Fino and Paolo Ferrazzi and {Di Mauro}, Michele and Calafiore, {Antonio Maria}",
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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.

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