Moderate mitral regurgitation in aortic root replacement surgery: Comparing mitral repair with no mitral repair
Objectives Patients often present for aortic root replacement surgery with concomitant mitral valve pathology. Moderate mitral regurgitation is the point of clinical equipoise where the benefits of intervention compared with observation are currently unknown. This study compares outcomes in patients...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2014-03, Vol.147 (3), p.938-941 |
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| creator | McCarthy, Fenton H., MD Desai, Nimesh D., MD, PhD Fox, Zachary, BA George, Justin, BA Moeller, Patrick, BS Vallabhajosyula, Prashanth, MD Szeto, Wilson Y., MD Bavaria, Joseph E., MD |
| description | Objectives Patients often present for aortic root replacement surgery with concomitant mitral valve pathology. Moderate mitral regurgitation is the point of clinical equipoise where the benefits of intervention compared with observation are currently unknown. This study compares outcomes in patients undergoing aortic root replacement surgery who did or did not receive a mitral valve repair for their preoperative moderate mitral regurgitation. Methods A total of 1316 patients who underwent aortic root replacement surgery between 2000 and 2011 were evaluated, with 104 patients meeting the inclusion criteria by presenting with moderate preoperative mitral regurgitation. A total of 73 patients (70%) received no mitral intervention, and 31 patients (30%) received a mitral repair. Patients underwent preoperative, postoperative, and greater than 6-month follow-up echocardiograms. Average clinical follow-up was 6.5 years. Results The mitral repair group had increased preoperative New York Heart Association III/IV and heart failure, longer crossclamp times, and more postoperative renal failure ( P = .0003, P = .04, P |
| doi_str_mv | 10.1016/j.jtcvs.2013.07.056 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1499152185</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0022522313008891</els_id><sourcerecordid>1499152185</sourcerecordid><originalsourceid>FETCH-LOGICAL-c459t-c70e430242e8a95367fba9e0cf61762cca892a51182c57b62e73e242908f6d7d3</originalsourceid><addsrcrecordid>eNqFkVGL1DAQx4Mo3nr6CQTpoy-tk6RpGkFBFk-Fk3tQwbeQTadratvUJD3Zb39Z91T05Z4GMr__DPkNIU8pVBRo82KohmSvY8WA8gpkBaK5RzYUlCybVny9TzYAjJWCMX5GHsU4AIAEqh6SM1YDF1zWG-I_-g6DSVhMLgUzFgH3a9i7ZJLzc-HmwviQnC2C9yk3l9FYnHBORcwYhsPLYuunxQQ37_-OWIwLxU-XvhWz__f1MXnQmzHik9t6Tr5cvP28fV9eXr37sH1zWdpaqFRaCVhzYDXD1ijBG9nvjEKwfUNlw6w1rWJGUNoyK-SuYSg5ZlpB2zed7Pg5eX6auwT_Y8WY9OSixXE0M_o1alorRQWjrcgoP6E2-BgD9noJbjLhoCnoo2k96F-m9dG0Bqmz6Zx6drtg3U3Y_cn8VpuBVycA8zevHQYdrcPZYucC2qQ77-5Y8Pq_vB3d7KwZv-MB4-DXMGeDmurINOhPx2Mfb005QNsqym8ALFSm3A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1499152185</pqid></control><display><type>article</type><title>Moderate mitral regurgitation in aortic root replacement surgery: Comparing mitral repair with no mitral repair</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>McCarthy, Fenton H., MD ; Desai, Nimesh D., MD, PhD ; Fox, Zachary, BA ; George, Justin, BA ; Moeller, Patrick, BS ; Vallabhajosyula, Prashanth, MD ; Szeto, Wilson Y., MD ; Bavaria, Joseph E., MD</creator><creatorcontrib>McCarthy, Fenton H., MD ; Desai, Nimesh D., MD, PhD ; Fox, Zachary, BA ; George, Justin, BA ; Moeller, Patrick, BS ; Vallabhajosyula, Prashanth, MD ; Szeto, Wilson Y., MD ; Bavaria, Joseph E., MD</creatorcontrib><description>Objectives Patients often present for aortic root replacement surgery with concomitant mitral valve pathology. Moderate mitral regurgitation is the point of clinical equipoise where the benefits of intervention compared with observation are currently unknown. This study compares outcomes in patients undergoing aortic root replacement surgery who did or did not receive a mitral valve repair for their preoperative moderate mitral regurgitation. Methods A total of 1316 patients who underwent aortic root replacement surgery between 2000 and 2011 were evaluated, with 104 patients meeting the inclusion criteria by presenting with moderate preoperative mitral regurgitation. A total of 73 patients (70%) received no mitral intervention, and 31 patients (30%) received a mitral repair. Patients underwent preoperative, postoperative, and greater than 6-month follow-up echocardiograms. Average clinical follow-up was 6.5 years. Results The mitral repair group had increased preoperative New York Heart Association III/IV and heart failure, longer crossclamp times, and more postoperative renal failure ( P = .0003, P = .04, P < .0001, and P = .03, respectively). The improvement in mitral regurgitation was greater for the mitral repair group (−2.1 ± 0.3 vs −1.1 ± 0.8, P < .0001), and mitral regurgitation remained significantly lower on follow-up at 6 months or more (0.6 ± 0.4 0.9 ± 0.2, P = .002). A significantly greater percentage of patients undergoing mitral repair compared with patients with no repair had improvement of at least 1 grade in mitral regurgitation postoperatively (100% vs 70%, P = .001) and on follow-up at 6 months or more (90% vs 61%, P = .006). There was no difference in long-term survival, freedom from 2+ or greater mitral regurgitation, or mitral reinterventions. Conclusions Mitral repair along with aortic root replacement has acceptable operative risk. Aortic root replacement surgery alone improved mitral regurgitation, but the addition of mitral repair further reduced mitral regurgitation, suggesting that repairing moderate mitral regurgitation should generally be considered along with aortic root replacement.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2013.07.056</identifier><identifier>PMID: 24035374</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Aortic Valve Insufficiency - diagnosis ; Aortic Valve Insufficiency - mortality ; Aortic Valve Insufficiency - physiopathology ; Aortic Valve Insufficiency - surgery ; Aortic Valve Stenosis - diagnosis ; Aortic Valve Stenosis - mortality ; Aortic Valve Stenosis - physiopathology ; Aortic Valve Stenosis - surgery ; Cardiothoracic Surgery ; Comorbidity ; Heart Failure - diagnosis ; Heart Failure - epidemiology ; Heart Valve Prosthesis Implantation - adverse effects ; Heart Valve Prosthesis Implantation - mortality ; Humans ; Incidence ; Mitral Valve Insufficiency - diagnosis ; Mitral Valve Insufficiency - mortality ; Mitral Valve Insufficiency - physiopathology ; Mitral Valve Insufficiency - surgery ; Patient Selection ; Pennsylvania - epidemiology ; Postoperative Complications - therapy ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Time Factors ; Treatment Outcome</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2014-03, Vol.147 (3), p.938-941</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2014 The American Association for Thoracic Surgery</rights><rights>Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-c70e430242e8a95367fba9e0cf61762cca892a51182c57b62e73e242908f6d7d3</citedby><cites>FETCH-LOGICAL-c459t-c70e430242e8a95367fba9e0cf61762cca892a51182c57b62e73e242908f6d7d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022522313008891$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24035374$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McCarthy, Fenton H., MD</creatorcontrib><creatorcontrib>Desai, Nimesh D., MD, PhD</creatorcontrib><creatorcontrib>Fox, Zachary, BA</creatorcontrib><creatorcontrib>George, Justin, BA</creatorcontrib><creatorcontrib>Moeller, Patrick, BS</creatorcontrib><creatorcontrib>Vallabhajosyula, Prashanth, MD</creatorcontrib><creatorcontrib>Szeto, Wilson Y., MD</creatorcontrib><creatorcontrib>Bavaria, Joseph E., MD</creatorcontrib><title>Moderate mitral regurgitation in aortic root replacement surgery: Comparing mitral repair with no mitral repair</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Objectives Patients often present for aortic root replacement surgery with concomitant mitral valve pathology. Moderate mitral regurgitation is the point of clinical equipoise where the benefits of intervention compared with observation are currently unknown. This study compares outcomes in patients undergoing aortic root replacement surgery who did or did not receive a mitral valve repair for their preoperative moderate mitral regurgitation. Methods A total of 1316 patients who underwent aortic root replacement surgery between 2000 and 2011 were evaluated, with 104 patients meeting the inclusion criteria by presenting with moderate preoperative mitral regurgitation. A total of 73 patients (70%) received no mitral intervention, and 31 patients (30%) received a mitral repair. Patients underwent preoperative, postoperative, and greater than 6-month follow-up echocardiograms. Average clinical follow-up was 6.5 years. Results The mitral repair group had increased preoperative New York Heart Association III/IV and heart failure, longer crossclamp times, and more postoperative renal failure ( P = .0003, P = .04, P < .0001, and P = .03, respectively). The improvement in mitral regurgitation was greater for the mitral repair group (−2.1 ± 0.3 vs −1.1 ± 0.8, P < .0001), and mitral regurgitation remained significantly lower on follow-up at 6 months or more (0.6 ± 0.4 0.9 ± 0.2, P = .002). A significantly greater percentage of patients undergoing mitral repair compared with patients with no repair had improvement of at least 1 grade in mitral regurgitation postoperatively (100% vs 70%, P = .001) and on follow-up at 6 months or more (90% vs 61%, P = .006). There was no difference in long-term survival, freedom from 2+ or greater mitral regurgitation, or mitral reinterventions. Conclusions Mitral repair along with aortic root replacement has acceptable operative risk. Aortic root replacement surgery alone improved mitral regurgitation, but the addition of mitral repair further reduced mitral regurgitation, suggesting that repairing moderate mitral regurgitation should generally be considered along with aortic root replacement.</description><subject>Aortic Valve Insufficiency - diagnosis</subject><subject>Aortic Valve Insufficiency - mortality</subject><subject>Aortic Valve Insufficiency - physiopathology</subject><subject>Aortic Valve Insufficiency - surgery</subject><subject>Aortic Valve Stenosis - diagnosis</subject><subject>Aortic Valve Stenosis - mortality</subject><subject>Aortic Valve Stenosis - physiopathology</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Cardiothoracic Surgery</subject><subject>Comorbidity</subject><subject>Heart Failure - diagnosis</subject><subject>Heart Failure - epidemiology</subject><subject>Heart Valve Prosthesis Implantation - adverse effects</subject><subject>Heart Valve Prosthesis Implantation - mortality</subject><subject>Humans</subject><subject>Incidence</subject><subject>Mitral Valve Insufficiency - diagnosis</subject><subject>Mitral Valve Insufficiency - mortality</subject><subject>Mitral Valve Insufficiency - physiopathology</subject><subject>Mitral Valve Insufficiency - surgery</subject><subject>Patient Selection</subject><subject>Pennsylvania - epidemiology</subject><subject>Postoperative Complications - therapy</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkVGL1DAQx4Mo3nr6CQTpoy-tk6RpGkFBFk-Fk3tQwbeQTadratvUJD3Zb39Z91T05Z4GMr__DPkNIU8pVBRo82KohmSvY8WA8gpkBaK5RzYUlCybVny9TzYAjJWCMX5GHsU4AIAEqh6SM1YDF1zWG-I_-g6DSVhMLgUzFgH3a9i7ZJLzc-HmwviQnC2C9yk3l9FYnHBORcwYhsPLYuunxQQ37_-OWIwLxU-XvhWz__f1MXnQmzHik9t6Tr5cvP28fV9eXr37sH1zWdpaqFRaCVhzYDXD1ijBG9nvjEKwfUNlw6w1rWJGUNoyK-SuYSg5ZlpB2zed7Pg5eX6auwT_Y8WY9OSixXE0M_o1alorRQWjrcgoP6E2-BgD9noJbjLhoCnoo2k96F-m9dG0Bqmz6Zx6drtg3U3Y_cn8VpuBVycA8zevHQYdrcPZYucC2qQ77-5Y8Pq_vB3d7KwZv-MB4-DXMGeDmurINOhPx2Mfb005QNsqym8ALFSm3A</recordid><startdate>20140301</startdate><enddate>20140301</enddate><creator>McCarthy, Fenton H., MD</creator><creator>Desai, Nimesh D., MD, PhD</creator><creator>Fox, Zachary, BA</creator><creator>George, Justin, BA</creator><creator>Moeller, Patrick, BS</creator><creator>Vallabhajosyula, Prashanth, MD</creator><creator>Szeto, Wilson Y., MD</creator><creator>Bavaria, Joseph E., MD</creator><general>Mosby, Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140301</creationdate><title>Moderate mitral regurgitation in aortic root replacement surgery: Comparing mitral repair with no mitral repair</title><author>McCarthy, Fenton H., MD ; Desai, Nimesh D., MD, PhD ; Fox, Zachary, BA ; George, Justin, BA ; Moeller, Patrick, BS ; Vallabhajosyula, Prashanth, MD ; Szeto, Wilson Y., MD ; Bavaria, Joseph E., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-c70e430242e8a95367fba9e0cf61762cca892a51182c57b62e73e242908f6d7d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aortic Valve Insufficiency - diagnosis</topic><topic>Aortic Valve Insufficiency - mortality</topic><topic>Aortic Valve Insufficiency - physiopathology</topic><topic>Aortic Valve Insufficiency - surgery</topic><topic>Aortic Valve Stenosis - diagnosis</topic><topic>Aortic Valve Stenosis - mortality</topic><topic>Aortic Valve Stenosis - physiopathology</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Cardiothoracic Surgery</topic><topic>Comorbidity</topic><topic>Heart Failure - diagnosis</topic><topic>Heart Failure - epidemiology</topic><topic>Heart Valve Prosthesis Implantation - adverse effects</topic><topic>Heart Valve Prosthesis Implantation - mortality</topic><topic>Humans</topic><topic>Incidence</topic><topic>Mitral Valve Insufficiency - diagnosis</topic><topic>Mitral Valve Insufficiency - mortality</topic><topic>Mitral Valve Insufficiency - physiopathology</topic><topic>Mitral Valve Insufficiency - surgery</topic><topic>Patient Selection</topic><topic>Pennsylvania - epidemiology</topic><topic>Postoperative Complications - therapy</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McCarthy, Fenton H., MD</creatorcontrib><creatorcontrib>Desai, Nimesh D., MD, PhD</creatorcontrib><creatorcontrib>Fox, Zachary, BA</creatorcontrib><creatorcontrib>George, Justin, BA</creatorcontrib><creatorcontrib>Moeller, Patrick, BS</creatorcontrib><creatorcontrib>Vallabhajosyula, Prashanth, MD</creatorcontrib><creatorcontrib>Szeto, Wilson Y., MD</creatorcontrib><creatorcontrib>Bavaria, Joseph E., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McCarthy, Fenton H., MD</au><au>Desai, Nimesh D., MD, PhD</au><au>Fox, Zachary, BA</au><au>George, Justin, BA</au><au>Moeller, Patrick, BS</au><au>Vallabhajosyula, Prashanth, MD</au><au>Szeto, Wilson Y., MD</au><au>Bavaria, Joseph E., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Moderate mitral regurgitation in aortic root replacement surgery: Comparing mitral repair with no mitral repair</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2014-03-01</date><risdate>2014</risdate><volume>147</volume><issue>3</issue><spage>938</spage><epage>941</epage><pages>938-941</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>Objectives Patients often present for aortic root replacement surgery with concomitant mitral valve pathology. Moderate mitral regurgitation is the point of clinical equipoise where the benefits of intervention compared with observation are currently unknown. This study compares outcomes in patients undergoing aortic root replacement surgery who did or did not receive a mitral valve repair for their preoperative moderate mitral regurgitation. Methods A total of 1316 patients who underwent aortic root replacement surgery between 2000 and 2011 were evaluated, with 104 patients meeting the inclusion criteria by presenting with moderate preoperative mitral regurgitation. A total of 73 patients (70%) received no mitral intervention, and 31 patients (30%) received a mitral repair. Patients underwent preoperative, postoperative, and greater than 6-month follow-up echocardiograms. Average clinical follow-up was 6.5 years. Results The mitral repair group had increased preoperative New York Heart Association III/IV and heart failure, longer crossclamp times, and more postoperative renal failure ( P = .0003, P = .04, P < .0001, and P = .03, respectively). The improvement in mitral regurgitation was greater for the mitral repair group (−2.1 ± 0.3 vs −1.1 ± 0.8, P < .0001), and mitral regurgitation remained significantly lower on follow-up at 6 months or more (0.6 ± 0.4 0.9 ± 0.2, P = .002). A significantly greater percentage of patients undergoing mitral repair compared with patients with no repair had improvement of at least 1 grade in mitral regurgitation postoperatively (100% vs 70%, P = .001) and on follow-up at 6 months or more (90% vs 61%, P = .006). There was no difference in long-term survival, freedom from 2+ or greater mitral regurgitation, or mitral reinterventions. Conclusions Mitral repair along with aortic root replacement has acceptable operative risk. Aortic root replacement surgery alone improved mitral regurgitation, but the addition of mitral repair further reduced mitral regurgitation, suggesting that repairing moderate mitral regurgitation should generally be considered along with aortic root replacement.</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>24035374</pmid><doi>10.1016/j.jtcvs.2013.07.056</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aortic Valve Insufficiency - diagnosis Aortic Valve Insufficiency - mortality Aortic Valve Insufficiency - physiopathology Aortic Valve Insufficiency - surgery Aortic Valve Stenosis - diagnosis Aortic Valve Stenosis - mortality Aortic Valve Stenosis - physiopathology Aortic Valve Stenosis - surgery Cardiothoracic Surgery Comorbidity Heart Failure - diagnosis Heart Failure - epidemiology Heart Valve Prosthesis Implantation - adverse effects Heart Valve Prosthesis Implantation - mortality Humans Incidence Mitral Valve Insufficiency - diagnosis Mitral Valve Insufficiency - mortality Mitral Valve Insufficiency - physiopathology Mitral Valve Insufficiency - surgery Patient Selection Pennsylvania - epidemiology Postoperative Complications - therapy Retrospective Studies Risk Factors Severity of Illness Index Time Factors Treatment Outcome |
| title | Moderate mitral regurgitation in aortic root replacement surgery: Comparing mitral repair with no mitral repair |
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