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Optimal surgical management of severe ischemic mitral regurgitation: to repair or to replace?

Publication ,  Journal Article
Perrault, LP; Moskowitz, AJ; Kron, IL; Acker, MA; Miller, MA; Horvath, KA; Thourani, VH; Argenziano, M; D'Alessandro, DA; Blackstone, EH ...
Published in: J Thorac Cardiovasc Surg
June 2012

BACKGROUND: Ischemic mitral regurgitation, a complication of myocardial infarction and coronary artery disease more generally, is associated with a high mortality rate and is estimated to affect 2.8 million Americans. With 1-year mortality rates as high as 40%, recent practice guidelines of professional societies recommend repair or replacement, but there remains a lack of conclusive evidence supporting either intervention. The choice between therapeutic options is characterized by the trade-off between reduced operative morbidity and mortality with repair versus a better long-term correction of mitral insufficiency with replacement. The long-term benefits of repair versus replacement remain unknown, which has led to significant variation in surgical practice. METHODS AND RESULTS: This article describes the design of a prospective randomized clinical trial to evaluate the safety and effectiveness of mitral valve repair and replacement in patients with severe ischemic mitral regurgitation. This trial is being conducted as part of the Cardiothoracic Surgical Trials Network. This article addresses challenges in selecting a feasible primary end point, characterizing the target population (including the degree of mitral regurgitation) and analytical challenges in this high mortality disease. CONCLUSIONS: The article concludes by discussing the importance of information on functional status, survival, neurocognition, quality of life, and cardiac physiology in therapeutic decision making.

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Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

June 2012

Volume

143

Issue

6

Start / End Page

1396 / 1403

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Severity of Illness Index
  • Respiratory System
  • Research Design
  • Prospective Studies
  • Myocardial Ischemia
  • Mitral Valve Insufficiency
  • Mitral Valve Annuloplasty
  • Humans
 

Citation

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Perrault, L. P., Moskowitz, A. J., Kron, I. L., Acker, M. A., Miller, M. A., Horvath, K. A., … Parides, M. K. (2012). Optimal surgical management of severe ischemic mitral regurgitation: to repair or to replace? J Thorac Cardiovasc Surg, 143(6), 1396–1403. https://doi.org/10.1016/j.jtcvs.2011.05.030
Perrault, Louis P., Alan J. Moskowitz, Irving L. Kron, Michael A. Acker, Marissa A. Miller, Keith A. Horvath, Vinod H. Thourani, et al. “Optimal surgical management of severe ischemic mitral regurgitation: to repair or to replace?J Thorac Cardiovasc Surg 143, no. 6 (June 2012): 1396–1403. https://doi.org/10.1016/j.jtcvs.2011.05.030.
Perrault LP, Moskowitz AJ, Kron IL, Acker MA, Miller MA, Horvath KA, et al. Optimal surgical management of severe ischemic mitral regurgitation: to repair or to replace? J Thorac Cardiovasc Surg. 2012 Jun;143(6):1396–403.
Perrault, Louis P., et al. “Optimal surgical management of severe ischemic mitral regurgitation: to repair or to replace?J Thorac Cardiovasc Surg, vol. 143, no. 6, June 2012, pp. 1396–403. Pubmed, doi:10.1016/j.jtcvs.2011.05.030.
Perrault LP, Moskowitz AJ, Kron IL, Acker MA, Miller MA, Horvath KA, Thourani VH, Argenziano M, D’Alessandro DA, Blackstone EH, Moy CS, Mathew JP, Hung J, Gardner TJ, Parides MK. Optimal surgical management of severe ischemic mitral regurgitation: to repair or to replace? J Thorac Cardiovasc Surg. 2012 Jun;143(6):1396–1403.
Journal cover image

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

June 2012

Volume

143

Issue

6

Start / End Page

1396 / 1403

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Severity of Illness Index
  • Respiratory System
  • Research Design
  • Prospective Studies
  • Myocardial Ischemia
  • Mitral Valve Insufficiency
  • Mitral Valve Annuloplasty
  • Humans