Ismail M Elnagar, Rawan Alghamdi, Murtadha H Alawami, Ahmad Alshammari, Abdulmalik A Almedimigh, Monirah A Albabtain, Alaa AlGhamdi, Huda H Ismail, Mostafa A Shalaby, Khaled A Alotaibi, Amr A Arafat
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Propensity score matching identified 140 matched pairs. The outcomes assessed included hospital mortality, long-term survival, recurrence of mitral regurgitation, mitral valve reintervention rates, and echocardiographic changes over time.</p><p><strong>Results: </strong>In the matched cohort, no significant differences were observed in hospital mortality (10% for MVr vs. 10.7% for MVR, <i>p</i> > 0.99) or long-term survival (<i>p</i> = 0.534). However, MVr was associated with a higher rate of recurrent moderate or higher mitral regurgitation (29.04% vs. 10.37%, <i>p</i> < 0.001) compared to MVR. The mitral valve reintervention rates did not differ significantly between the groups. Echocardiographic follow-up revealed significant improvements in left ventricular function and dimensions, with no significant differences between the groups. A subgroup analysis revealed no difference in survival according to the age, gender, ejection fraction, EuroSCORE category, or right ventricular function between the MVr and MVR patients.</p><p><strong>Conclusions: </strong>MVr and MVR for IMR yielded comparable survival rates, but MVr was associated with a higher risk of recurrent MR. The efficacy of both surgical approaches across diverse patient populations was comparable, reinforcing the need for individualized decision-making based on other clinical and anatomical considerations.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":"12 4","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12027820/pdf/","citationCount":"0","resultStr":"{\"title\":\"Long-Term Outcomes of Mitral Valve Repair Versus Replacement in Patients with Ischemic Mitral Regurgitation: A Retrospective Propensity-Matched Analysis.\",\"authors\":\"Ismail M Elnagar, Rawan Alghamdi, Murtadha H Alawami, Ahmad Alshammari, Abdulmalik A Almedimigh, Monirah A Albabtain, Alaa AlGhamdi, Huda H Ismail, Mostafa A Shalaby, Khaled A Alotaibi, Amr A Arafat\",\"doi\":\"10.3390/jcdd12040109\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The optimal surgical management of ischemic mitral regurgitation (IMR)-mitral valve repair (MVr) versus mitral valve replacement (MVR)-remains controversial, with limited evidence on long-term outcomes. This study aimed to compare the outcomes of MVr and MVR in patients with IMR, focusing on survival and recurrence of mitral regurgitation. Additionally, survival was compared based on preoperative characteristics.</p><p><strong>Methods: </strong>A retrospective cohort analysis was conducted at a tertiary referral center and included 759 patients who underwent surgery for IMR between 2009 and 2021. Propensity score matching identified 140 matched pairs. The outcomes assessed included hospital mortality, long-term survival, recurrence of mitral regurgitation, mitral valve reintervention rates, and echocardiographic changes over time.</p><p><strong>Results: </strong>In the matched cohort, no significant differences were observed in hospital mortality (10% for MVr vs. 10.7% for MVR, <i>p</i> > 0.99) or long-term survival (<i>p</i> = 0.534). However, MVr was associated with a higher rate of recurrent moderate or higher mitral regurgitation (29.04% vs. 10.37%, <i>p</i> < 0.001) compared to MVR. The mitral valve reintervention rates did not differ significantly between the groups. Echocardiographic follow-up revealed significant improvements in left ventricular function and dimensions, with no significant differences between the groups. A subgroup analysis revealed no difference in survival according to the age, gender, ejection fraction, EuroSCORE category, or right ventricular function between the MVr and MVR patients.</p><p><strong>Conclusions: </strong>MVr and MVR for IMR yielded comparable survival rates, but MVr was associated with a higher risk of recurrent MR. The efficacy of both surgical approaches across diverse patient populations was comparable, reinforcing the need for individualized decision-making based on other clinical and anatomical considerations.</p>\",\"PeriodicalId\":15197,\"journal\":{\"name\":\"Journal of Cardiovascular Development and Disease\",\"volume\":\"12 4\",\"pages\":\"\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-03-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12027820/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cardiovascular Development and Disease\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3390/jcdd12040109\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiovascular Development and Disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3390/jcdd12040109","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景：缺血性二尖瓣反流（IMR）的最佳手术治疗方法是二尖瓣修复（MVr）还是二尖瓣置换术（MVr）仍然存在争议，关于长期结果的证据有限。本研究旨在比较MVr和MVr在IMR患者中的结果，重点关注二尖瓣反流的生存和复发。此外，根据术前特征比较生存率。方法：在一家三级转诊中心进行回顾性队列分析，纳入2009年至2021年期间接受IMR手术的759例患者。倾向得分匹配确定了140对匹配的配对。评估的结果包括医院死亡率、长期生存率、二尖瓣返流复发率、二尖瓣再介入率和超声心动图随时间的变化。结果：在匹配的队列中，在医院死亡率（MVr组为10%，MVr组为10.7%,p = 0.99）或长期生存率（p = 0.534）方面没有观察到显著差异。然而，与MVr相比，MVr与中度或重度二尖瓣反流复发率较高相关（29.04% vs. 10.37%, p < 0.001）。两组间二尖瓣再干预率无显著差异。超声心动图随访显示左心室功能和尺寸显著改善，组间无显著差异。亚组分析显示MVr和MVr患者的生存率根据年龄、性别、射血分数、EuroSCORE分类或右心室功能没有差异。结论：MVr和MVr治疗IMR的生存率相当，但MVr与mr复发风险较高相关。两种手术入路在不同患者群体中的疗效是相当的，这加强了基于其他临床和解剖学考虑的个性化决策的必要性。
Long-Term Outcomes of Mitral Valve Repair Versus Replacement in Patients with Ischemic Mitral Regurgitation: A Retrospective Propensity-Matched Analysis.
Background: The optimal surgical management of ischemic mitral regurgitation (IMR)-mitral valve repair (MVr) versus mitral valve replacement (MVR)-remains controversial, with limited evidence on long-term outcomes. This study aimed to compare the outcomes of MVr and MVR in patients with IMR, focusing on survival and recurrence of mitral regurgitation. Additionally, survival was compared based on preoperative characteristics.
Methods: A retrospective cohort analysis was conducted at a tertiary referral center and included 759 patients who underwent surgery for IMR between 2009 and 2021. Propensity score matching identified 140 matched pairs. The outcomes assessed included hospital mortality, long-term survival, recurrence of mitral regurgitation, mitral valve reintervention rates, and echocardiographic changes over time.
Results: In the matched cohort, no significant differences were observed in hospital mortality (10% for MVr vs. 10.7% for MVR, p > 0.99) or long-term survival (p = 0.534). However, MVr was associated with a higher rate of recurrent moderate or higher mitral regurgitation (29.04% vs. 10.37%, p < 0.001) compared to MVR. The mitral valve reintervention rates did not differ significantly between the groups. Echocardiographic follow-up revealed significant improvements in left ventricular function and dimensions, with no significant differences between the groups. A subgroup analysis revealed no difference in survival according to the age, gender, ejection fraction, EuroSCORE category, or right ventricular function between the MVr and MVR patients.
Conclusions: MVr and MVR for IMR yielded comparable survival rates, but MVr was associated with a higher risk of recurrent MR. The efficacy of both surgical approaches across diverse patient populations was comparable, reinforcing the need for individualized decision-making based on other clinical and anatomical considerations.
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