Degenerative Mitral Regurgitation After Nonmitral Cardiac Surgery: MitraClip Versus Surgical Reconstruction.
Aged
Cardiac Surgical Procedures
/ adverse effects
Female
Follow-Up Studies
Heart Valve Prosthesis
Humans
Male
Mitral Valve
/ diagnostic imaging
Mitral Valve Annuloplasty
/ methods
Mitral Valve Insufficiency
/ diagnosis
Prosthesis Design
Reoperation
Retrospective Studies
Severity of Illness Index
Treatment Outcome
Journal
The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
10
02
2018
revised:
08
09
2018
accepted:
17
09
2018
pubmed:
6
11
2018
medline:
12
11
2019
entrez:
6
11
2018
Statut:
ppublish
Résumé
Surgical mitral valve repair is the conventional treatment for severe degenerative mitral regurgitation (MR). MitraClip therapy has emerged as a viable option in high-risk surgical patients. We sought to compare conventional surgery to MitraClip therapy in patients with severe degenerative mitral valve prolapse (MVP) and previous cardiac interventions. From January 2012 to May 2016, 131 patients with previous cardiac surgery and subsequent intervention for degenerative MVP were included in this analysis: 75 (57.3%) underwent surgical repair and 56 (42.7%) underwent MitraClip placement. Follow-up was available in all early survivors at median of 11 (interquartile range, 0 to 32) months for surgery and 11 (interquartile range, 3 to 21) months for MitraClip patients. MitraClip patients were older (75.7 ± 8.6 years of age versus 68.6 ± 13.1 of age; p < 0.001), and had higher Society of Thoracic Surgeons risk scores (5.8 ± 2.4 versus 2.7 ± 2.3; p < 0.001). Median length-of-stay was 7 (interquartile range, 5 to 11) days for surgery and 2 (interquartile range, 2 to 4) days for MitraClip patients (p < 0.001), but 30-day mortality was comparable between the 2 groups (2.7% versus 3.6%; p = 0.77). Recurrent MR (moderate or severe) was significantly higher for MitraClip patients, both at discharge (43.1% versus 5.4%; p < 0.001) and at 1-year follow-up (66.7% versus 33.3%; p = 0.02). At 1 year postintervention, freedom from mitral reintervention was significantly higher for surgical patients (100.0% versus 87.5%; p = 0.006). In patients with previous cardiac interventions and severe degenerative MVP, a repeat conventional surgery is safe and durable. Percutaneous MitraClip repair is effective but associated with higher risk of residual MR, and should only be considered in selected patients. Careful patient selection using a heart team approach is recommended.
Sections du résumé
BACKGROUND
Surgical mitral valve repair is the conventional treatment for severe degenerative mitral regurgitation (MR). MitraClip therapy has emerged as a viable option in high-risk surgical patients. We sought to compare conventional surgery to MitraClip therapy in patients with severe degenerative mitral valve prolapse (MVP) and previous cardiac interventions.
METHODS
From January 2012 to May 2016, 131 patients with previous cardiac surgery and subsequent intervention for degenerative MVP were included in this analysis: 75 (57.3%) underwent surgical repair and 56 (42.7%) underwent MitraClip placement. Follow-up was available in all early survivors at median of 11 (interquartile range, 0 to 32) months for surgery and 11 (interquartile range, 3 to 21) months for MitraClip patients.
RESULTS
MitraClip patients were older (75.7 ± 8.6 years of age versus 68.6 ± 13.1 of age; p < 0.001), and had higher Society of Thoracic Surgeons risk scores (5.8 ± 2.4 versus 2.7 ± 2.3; p < 0.001). Median length-of-stay was 7 (interquartile range, 5 to 11) days for surgery and 2 (interquartile range, 2 to 4) days for MitraClip patients (p < 0.001), but 30-day mortality was comparable between the 2 groups (2.7% versus 3.6%; p = 0.77). Recurrent MR (moderate or severe) was significantly higher for MitraClip patients, both at discharge (43.1% versus 5.4%; p < 0.001) and at 1-year follow-up (66.7% versus 33.3%; p = 0.02). At 1 year postintervention, freedom from mitral reintervention was significantly higher for surgical patients (100.0% versus 87.5%; p = 0.006).
CONCLUSIONS
In patients with previous cardiac interventions and severe degenerative MVP, a repeat conventional surgery is safe and durable. Percutaneous MitraClip repair is effective but associated with higher risk of residual MR, and should only be considered in selected patients. Careful patient selection using a heart team approach is recommended.
Identifiants
pubmed: 30395854
pii: S0003-4975(18)31554-6
doi: 10.1016/j.athoracsur.2018.09.036
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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Informations de copyright
Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.