Mitral-valve repair versus replacement for severe ischemic mitral regurgitation

Michael A. Acker, Michael K. Parides, Louis P. Perrault, Alan J. Moskowitz, Annetine C. Gelijns, Pierre Voisine, Peter K. Smith, Judy W. Hung, Eugene H. Blackstone, John D. Puskas, Michael Argenziano, James S. Gammie, Michael Mack, Deborah D. Ascheim, Emilia Bagiella, Ellen G. Moquete, T. Bruce Ferguson, Keith A. Horvath, Nancy L. Geller, Marissa A. Miller & 8 others Y. Joseph Woo, David A. D'Alessandro, Gorav Ailawadi, Francois Dagenais, Timothy J. Gardner, Patrick T. O'Gara, Robert E. Michler, Irving L. Kron

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Ischemic mitral regurgitation is associated with a substantial risk of death. Practice guidelines recommend surgery for patients with a severe form of this condition but acknowledge that the supporting evidence for repair or replacement is limited. METHODS: We randomly assigned 251 patients with severe ischemic mitral regurgitation to undergo either mitral-valve repair or chordal-sparing replacement in order to evaluate efficacy and safety. The primary end point was the left ventricular end-systolic volume index (LVESVI) at 12 months, as assessed with the use of a Wilcoxon rank-sum test in which deaths were categorized below the lowest LVESVI rank. RESULTS: At 12 months, the mean LVESVI among surviving patients was 54.6±25.0 ml per square meter of body-surface area in the repair group and 60.7±31.5 ml per square meter in the replacement group (mean change from baseline, -6.6 and -6.8 ml per square meter, respectively). The rate of death was 14.3% in the repair group and 17.6% in the replacement group (hazard ratio with repair, 0.79; 95% confidence interval, 0.42 to 1.47; P = 0.45 by the log-rank test). There was no significant between-group difference in LVESVI after adjustment for death (z score, 1.33; P = 0.18). The rate of moderate or severe recurrence of mitral regurgitation at 12 months was higher in the repair group than in the replacement group (32.6% vs. 2.3%, P

Original languageEnglish (US)
Pages (from-to)23-32
Number of pages10
JournalNew England Journal of Medicine
Volume370
Issue number1
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Mitral Valve Insufficiency
Mitral Valve
Stroke Volume
Nonparametric Statistics
Body Surface Area
Practice Guidelines
Confidence Intervals
Safety
Recurrence
Mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Acker, M. A., Parides, M. K., Perrault, L. P., Moskowitz, A. J., Gelijns, A. C., Voisine, P., ... Kron, I. L. (2014). Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. New England Journal of Medicine, 370(1), 23-32. https://doi.org/10.1056/NEJMoa1312808

Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. / Acker, Michael A.; Parides, Michael K.; Perrault, Louis P.; Moskowitz, Alan J.; Gelijns, Annetine C.; Voisine, Pierre; Smith, Peter K.; Hung, Judy W.; Blackstone, Eugene H.; Puskas, John D.; Argenziano, Michael; Gammie, James S.; Mack, Michael; Ascheim, Deborah D.; Bagiella, Emilia; Moquete, Ellen G.; Ferguson, T. Bruce; Horvath, Keith A.; Geller, Nancy L.; Miller, Marissa A.; Woo, Y. Joseph; D'Alessandro, David A.; Ailawadi, Gorav; Dagenais, Francois; Gardner, Timothy J.; O'Gara, Patrick T.; Michler, Robert E.; Kron, Irving L.

In: New England Journal of Medicine, Vol. 370, No. 1, 2014, p. 23-32.

Research output: Contribution to journalArticle

Acker, MA, Parides, MK, Perrault, LP, Moskowitz, AJ, Gelijns, AC, Voisine, P, Smith, PK, Hung, JW, Blackstone, EH, Puskas, JD, Argenziano, M, Gammie, JS, Mack, M, Ascheim, DD, Bagiella, E, Moquete, EG, Ferguson, TB, Horvath, KA, Geller, NL, Miller, MA, Woo, YJ, D'Alessandro, DA, Ailawadi, G, Dagenais, F, Gardner, TJ, O'Gara, PT, Michler, RE & Kron, IL 2014, 'Mitral-valve repair versus replacement for severe ischemic mitral regurgitation', New England Journal of Medicine, vol. 370, no. 1, pp. 23-32. https://doi.org/10.1056/NEJMoa1312808
Acker MA, Parides MK, Perrault LP, Moskowitz AJ, Gelijns AC, Voisine P et al. Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. New England Journal of Medicine. 2014;370(1):23-32. https://doi.org/10.1056/NEJMoa1312808
Acker, Michael A. ; Parides, Michael K. ; Perrault, Louis P. ; Moskowitz, Alan J. ; Gelijns, Annetine C. ; Voisine, Pierre ; Smith, Peter K. ; Hung, Judy W. ; Blackstone, Eugene H. ; Puskas, John D. ; Argenziano, Michael ; Gammie, James S. ; Mack, Michael ; Ascheim, Deborah D. ; Bagiella, Emilia ; Moquete, Ellen G. ; Ferguson, T. Bruce ; Horvath, Keith A. ; Geller, Nancy L. ; Miller, Marissa A. ; Woo, Y. Joseph ; D'Alessandro, David A. ; Ailawadi, Gorav ; Dagenais, Francois ; Gardner, Timothy J. ; O'Gara, Patrick T. ; Michler, Robert E. ; Kron, Irving L. / Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. In: New England Journal of Medicine. 2014 ; Vol. 370, No. 1. pp. 23-32.
@article{b218326c69914489b619d7ded7e02e70,
title = "Mitral-valve repair versus replacement for severe ischemic mitral regurgitation",
abstract = "BACKGROUND: Ischemic mitral regurgitation is associated with a substantial risk of death. Practice guidelines recommend surgery for patients with a severe form of this condition but acknowledge that the supporting evidence for repair or replacement is limited. METHODS: We randomly assigned 251 patients with severe ischemic mitral regurgitation to undergo either mitral-valve repair or chordal-sparing replacement in order to evaluate efficacy and safety. The primary end point was the left ventricular end-systolic volume index (LVESVI) at 12 months, as assessed with the use of a Wilcoxon rank-sum test in which deaths were categorized below the lowest LVESVI rank. RESULTS: At 12 months, the mean LVESVI among surviving patients was 54.6±25.0 ml per square meter of body-surface area in the repair group and 60.7±31.5 ml per square meter in the replacement group (mean change from baseline, -6.6 and -6.8 ml per square meter, respectively). The rate of death was 14.3{\%} in the repair group and 17.6{\%} in the replacement group (hazard ratio with repair, 0.79; 95{\%} confidence interval, 0.42 to 1.47; P = 0.45 by the log-rank test). There was no significant between-group difference in LVESVI after adjustment for death (z score, 1.33; P = 0.18). The rate of moderate or severe recurrence of mitral regurgitation at 12 months was higher in the repair group than in the replacement group (32.6{\%} vs. 2.3{\%}, P",
author = "Acker, {Michael A.} and Parides, {Michael K.} and Perrault, {Louis P.} and Moskowitz, {Alan J.} and Gelijns, {Annetine C.} and Pierre Voisine and Smith, {Peter K.} and Hung, {Judy W.} and Blackstone, {Eugene H.} and Puskas, {John D.} and Michael Argenziano and Gammie, {James S.} and Michael Mack and Ascheim, {Deborah D.} and Emilia Bagiella and Moquete, {Ellen G.} and Ferguson, {T. Bruce} and Horvath, {Keith A.} and Geller, {Nancy L.} and Miller, {Marissa A.} and Woo, {Y. Joseph} and D'Alessandro, {David A.} and Gorav Ailawadi and Francois Dagenais and Gardner, {Timothy J.} and O'Gara, {Patrick T.} and Michler, {Robert E.} and Kron, {Irving L.}",
year = "2014",
doi = "10.1056/NEJMoa1312808",
language = "English (US)",
volume = "370",
pages = "23--32",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "1",

}

TY - JOUR

T1 - Mitral-valve repair versus replacement for severe ischemic mitral regurgitation

AU - Acker, Michael A.

AU - Parides, Michael K.

AU - Perrault, Louis P.

AU - Moskowitz, Alan J.

AU - Gelijns, Annetine C.

AU - Voisine, Pierre

AU - Smith, Peter K.

AU - Hung, Judy W.

AU - Blackstone, Eugene H.

AU - Puskas, John D.

AU - Argenziano, Michael

AU - Gammie, James S.

AU - Mack, Michael

AU - Ascheim, Deborah D.

AU - Bagiella, Emilia

AU - Moquete, Ellen G.

AU - Ferguson, T. Bruce

AU - Horvath, Keith A.

AU - Geller, Nancy L.

AU - Miller, Marissa A.

AU - Woo, Y. Joseph

AU - D'Alessandro, David A.

AU - Ailawadi, Gorav

AU - Dagenais, Francois

AU - Gardner, Timothy J.

AU - O'Gara, Patrick T.

AU - Michler, Robert E.

AU - Kron, Irving L.

PY - 2014

Y1 - 2014

N2 - BACKGROUND: Ischemic mitral regurgitation is associated with a substantial risk of death. Practice guidelines recommend surgery for patients with a severe form of this condition but acknowledge that the supporting evidence for repair or replacement is limited. METHODS: We randomly assigned 251 patients with severe ischemic mitral regurgitation to undergo either mitral-valve repair or chordal-sparing replacement in order to evaluate efficacy and safety. The primary end point was the left ventricular end-systolic volume index (LVESVI) at 12 months, as assessed with the use of a Wilcoxon rank-sum test in which deaths were categorized below the lowest LVESVI rank. RESULTS: At 12 months, the mean LVESVI among surviving patients was 54.6±25.0 ml per square meter of body-surface area in the repair group and 60.7±31.5 ml per square meter in the replacement group (mean change from baseline, -6.6 and -6.8 ml per square meter, respectively). The rate of death was 14.3% in the repair group and 17.6% in the replacement group (hazard ratio with repair, 0.79; 95% confidence interval, 0.42 to 1.47; P = 0.45 by the log-rank test). There was no significant between-group difference in LVESVI after adjustment for death (z score, 1.33; P = 0.18). The rate of moderate or severe recurrence of mitral regurgitation at 12 months was higher in the repair group than in the replacement group (32.6% vs. 2.3%, P

AB - BACKGROUND: Ischemic mitral regurgitation is associated with a substantial risk of death. Practice guidelines recommend surgery for patients with a severe form of this condition but acknowledge that the supporting evidence for repair or replacement is limited. METHODS: We randomly assigned 251 patients with severe ischemic mitral regurgitation to undergo either mitral-valve repair or chordal-sparing replacement in order to evaluate efficacy and safety. The primary end point was the left ventricular end-systolic volume index (LVESVI) at 12 months, as assessed with the use of a Wilcoxon rank-sum test in which deaths were categorized below the lowest LVESVI rank. RESULTS: At 12 months, the mean LVESVI among surviving patients was 54.6±25.0 ml per square meter of body-surface area in the repair group and 60.7±31.5 ml per square meter in the replacement group (mean change from baseline, -6.6 and -6.8 ml per square meter, respectively). The rate of death was 14.3% in the repair group and 17.6% in the replacement group (hazard ratio with repair, 0.79; 95% confidence interval, 0.42 to 1.47; P = 0.45 by the log-rank test). There was no significant between-group difference in LVESVI after adjustment for death (z score, 1.33; P = 0.18). The rate of moderate or severe recurrence of mitral regurgitation at 12 months was higher in the repair group than in the replacement group (32.6% vs. 2.3%, P

UR - http://www.scopus.com/inward/record.url?scp=84891123882&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84891123882&partnerID=8YFLogxK

U2 - 10.1056/NEJMoa1312808

DO - 10.1056/NEJMoa1312808

M3 - Article

VL - 370

SP - 23

EP - 32

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 1

ER -