Mitral Repair Is Superior to Replacement When Associated with Coronary Artery Disease

T. Brett Reece, Curtis G. Tribble, Peter I. Ellman, Thomas S. Maxey, Randall L. Woodford, George M. Dimeling, Harry A. Wellons, Ivan K. Crosby, John A. Kern, Irving L. Kron, William A Baumgartner, Fred A. Crawford, Lynn H. Harrison

Research output: Contribution to journalArticle

Abstract

Objective: To compare the outcomes of mitral repair and replacement in revascularized patients with ischemic mitral regurgitation. Summary Background Data: Combined coronary bypass (CABG) and mitral procedures have been associated with the highest mortality (>10%) in cardiac surgery. Recent studies have suggested that mitral valve replacement (MVR) with sparing of the subvalvular apparatus had comparable results to mitral repair when associated with CABG. Methods: Over the past 7 years, 54 patients had CABG/mitral repair versus 56 who had CABG/MVR with preservation of the subvalvular apparatus. The groups were similar in age at 69.2 years in the replacement group versus 67.0 in the repair group. We compared these 2 groups based on hospital mortality, incidence of complications including nosocomial infection, neurologic decompensation (stroke), pulmonary complication (pneumonia, atelectasis, and prolonged ventilation), and renal complications (acute renal failure or insufficiency). Results: The mitral repair group had a hospital mortality of 1.9% versus 10.7% in the replacement group (P = 0.05). Infection occurred in 9% of repairs compared with 13% of replacements (P = 0.59). The incidence of stroke was no different between groups (2 of 54 repairs vs. 2 of 56 replacements, P = 1.00). Pulmonary complication rate was 39% in repairs versus 32% in replacements (P = 0.59). Worsening renal function occurred in 15% of repairs versus 18% of replacements (P = 0.67). Conclusions: Mitral repair is superior to mitral replacement when associated with coronary artery disease in terms of perioperative morbidity and hospital mortality. Although preservation of the subvalvular apparatus with MVR has a theoretical advantage in terms of ventricular function, mitral repair clearly adds a survival benefit in patients with concomitant ischemic cardiac disease.

Original languageEnglish (US)
Pages (from-to)671-677
Number of pages7
JournalAnnals of Surgery
Volume239
Issue number5
DOIs
StatePublished - May 2004
Externally publishedYes

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Hospital Mortality
Mitral Valve
Coronary Artery Disease
Acute Kidney Injury
Stroke
Kidney
Lung
Pulmonary Atelectasis
Ventricular Function
Incidence
Mitral Valve Insufficiency
Cross Infection
Nervous System
Thoracic Surgery
Ventilation
Heart Diseases
Pneumonia
Morbidity
Survival
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Reece, T. B., Tribble, C. G., Ellman, P. I., Maxey, T. S., Woodford, R. L., Dimeling, G. M., ... Harrison, L. H. (2004). Mitral Repair Is Superior to Replacement When Associated with Coronary Artery Disease. Annals of Surgery, 239(5), 671-677. https://doi.org/10.1097/01.sla.0000124297.40815.86

Mitral Repair Is Superior to Replacement When Associated with Coronary Artery Disease. / Reece, T. Brett; Tribble, Curtis G.; Ellman, Peter I.; Maxey, Thomas S.; Woodford, Randall L.; Dimeling, George M.; Wellons, Harry A.; Crosby, Ivan K.; Kern, John A.; Kron, Irving L.; Baumgartner, William A; Crawford, Fred A.; Harrison, Lynn H.

In: Annals of Surgery, Vol. 239, No. 5, 05.2004, p. 671-677.

Research output: Contribution to journalArticle

Reece, TB, Tribble, CG, Ellman, PI, Maxey, TS, Woodford, RL, Dimeling, GM, Wellons, HA, Crosby, IK, Kern, JA, Kron, IL, Baumgartner, WA, Crawford, FA & Harrison, LH 2004, 'Mitral Repair Is Superior to Replacement When Associated with Coronary Artery Disease', Annals of Surgery, vol. 239, no. 5, pp. 671-677. https://doi.org/10.1097/01.sla.0000124297.40815.86
Reece TB, Tribble CG, Ellman PI, Maxey TS, Woodford RL, Dimeling GM et al. Mitral Repair Is Superior to Replacement When Associated with Coronary Artery Disease. Annals of Surgery. 2004 May;239(5):671-677. https://doi.org/10.1097/01.sla.0000124297.40815.86
Reece, T. Brett ; Tribble, Curtis G. ; Ellman, Peter I. ; Maxey, Thomas S. ; Woodford, Randall L. ; Dimeling, George M. ; Wellons, Harry A. ; Crosby, Ivan K. ; Kern, John A. ; Kron, Irving L. ; Baumgartner, William A ; Crawford, Fred A. ; Harrison, Lynn H. / Mitral Repair Is Superior to Replacement When Associated with Coronary Artery Disease. In: Annals of Surgery. 2004 ; Vol. 239, No. 5. pp. 671-677.
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abstract = "Objective: To compare the outcomes of mitral repair and replacement in revascularized patients with ischemic mitral regurgitation. Summary Background Data: Combined coronary bypass (CABG) and mitral procedures have been associated with the highest mortality (>10{\%}) in cardiac surgery. Recent studies have suggested that mitral valve replacement (MVR) with sparing of the subvalvular apparatus had comparable results to mitral repair when associated with CABG. Methods: Over the past 7 years, 54 patients had CABG/mitral repair versus 56 who had CABG/MVR with preservation of the subvalvular apparatus. The groups were similar in age at 69.2 years in the replacement group versus 67.0 in the repair group. We compared these 2 groups based on hospital mortality, incidence of complications including nosocomial infection, neurologic decompensation (stroke), pulmonary complication (pneumonia, atelectasis, and prolonged ventilation), and renal complications (acute renal failure or insufficiency). Results: The mitral repair group had a hospital mortality of 1.9{\%} versus 10.7{\%} in the replacement group (P = 0.05). Infection occurred in 9{\%} of repairs compared with 13{\%} of replacements (P = 0.59). The incidence of stroke was no different between groups (2 of 54 repairs vs. 2 of 56 replacements, P = 1.00). Pulmonary complication rate was 39{\%} in repairs versus 32{\%} in replacements (P = 0.59). Worsening renal function occurred in 15{\%} of repairs versus 18{\%} of replacements (P = 0.67). Conclusions: Mitral repair is superior to mitral replacement when associated with coronary artery disease in terms of perioperative morbidity and hospital mortality. Although preservation of the subvalvular apparatus with MVR has a theoretical advantage in terms of ventricular function, mitral repair clearly adds a survival benefit in patients with concomitant ischemic cardiac disease.",
author = "Reece, {T. Brett} and Tribble, {Curtis G.} and Ellman, {Peter I.} and Maxey, {Thomas S.} and Woodford, {Randall L.} and Dimeling, {George M.} and Wellons, {Harry A.} and Crosby, {Ivan K.} and Kern, {John A.} and Kron, {Irving L.} and Baumgartner, {William A} and Crawford, {Fred A.} and Harrison, {Lynn H.}",
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T1 - Mitral Repair Is Superior to Replacement When Associated with Coronary Artery Disease

AU - Reece, T. Brett

AU - Tribble, Curtis G.

AU - Ellman, Peter I.

AU - Maxey, Thomas S.

AU - Woodford, Randall L.

AU - Dimeling, George M.

AU - Wellons, Harry A.

AU - Crosby, Ivan K.

AU - Kern, John A.

AU - Kron, Irving L.

AU - Baumgartner, William A

AU - Crawford, Fred A.

AU - Harrison, Lynn H.

PY - 2004/5

Y1 - 2004/5

N2 - Objective: To compare the outcomes of mitral repair and replacement in revascularized patients with ischemic mitral regurgitation. Summary Background Data: Combined coronary bypass (CABG) and mitral procedures have been associated with the highest mortality (>10%) in cardiac surgery. Recent studies have suggested that mitral valve replacement (MVR) with sparing of the subvalvular apparatus had comparable results to mitral repair when associated with CABG. Methods: Over the past 7 years, 54 patients had CABG/mitral repair versus 56 who had CABG/MVR with preservation of the subvalvular apparatus. The groups were similar in age at 69.2 years in the replacement group versus 67.0 in the repair group. We compared these 2 groups based on hospital mortality, incidence of complications including nosocomial infection, neurologic decompensation (stroke), pulmonary complication (pneumonia, atelectasis, and prolonged ventilation), and renal complications (acute renal failure or insufficiency). Results: The mitral repair group had a hospital mortality of 1.9% versus 10.7% in the replacement group (P = 0.05). Infection occurred in 9% of repairs compared with 13% of replacements (P = 0.59). The incidence of stroke was no different between groups (2 of 54 repairs vs. 2 of 56 replacements, P = 1.00). Pulmonary complication rate was 39% in repairs versus 32% in replacements (P = 0.59). Worsening renal function occurred in 15% of repairs versus 18% of replacements (P = 0.67). Conclusions: Mitral repair is superior to mitral replacement when associated with coronary artery disease in terms of perioperative morbidity and hospital mortality. Although preservation of the subvalvular apparatus with MVR has a theoretical advantage in terms of ventricular function, mitral repair clearly adds a survival benefit in patients with concomitant ischemic cardiac disease.

AB - Objective: To compare the outcomes of mitral repair and replacement in revascularized patients with ischemic mitral regurgitation. Summary Background Data: Combined coronary bypass (CABG) and mitral procedures have been associated with the highest mortality (>10%) in cardiac surgery. Recent studies have suggested that mitral valve replacement (MVR) with sparing of the subvalvular apparatus had comparable results to mitral repair when associated with CABG. Methods: Over the past 7 years, 54 patients had CABG/mitral repair versus 56 who had CABG/MVR with preservation of the subvalvular apparatus. The groups were similar in age at 69.2 years in the replacement group versus 67.0 in the repair group. We compared these 2 groups based on hospital mortality, incidence of complications including nosocomial infection, neurologic decompensation (stroke), pulmonary complication (pneumonia, atelectasis, and prolonged ventilation), and renal complications (acute renal failure or insufficiency). Results: The mitral repair group had a hospital mortality of 1.9% versus 10.7% in the replacement group (P = 0.05). Infection occurred in 9% of repairs compared with 13% of replacements (P = 0.59). The incidence of stroke was no different between groups (2 of 54 repairs vs. 2 of 56 replacements, P = 1.00). Pulmonary complication rate was 39% in repairs versus 32% in replacements (P = 0.59). Worsening renal function occurred in 15% of repairs versus 18% of replacements (P = 0.67). Conclusions: Mitral repair is superior to mitral replacement when associated with coronary artery disease in terms of perioperative morbidity and hospital mortality. Although preservation of the subvalvular apparatus with MVR has a theoretical advantage in terms of ventricular function, mitral repair clearly adds a survival benefit in patients with concomitant ischemic cardiac disease.

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