1. Twenty-Year Outcome after Mitral Repair Versus Replacement for Severe Degenerative Mitral Regurgitation: Analysis of a Large, Prospective, Multicenter, International Registry
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Siham Lazam, Jean-Louis Vanoverschelde, Christophe Tribouilloy, Francesco Grigioni, Rakesh M. Suri, Jean-Francois Avierinos, Christophe de Meester, Andrea Barbieri, Dan Rusinaru, Antonio Russo, Agnès Pasquet, Hector I. Michelena, Marianne Huebner, Joseph Maalouf, Marie-Annick Clavel, Catherine Szymanski, Maurice Enriquez-Sarano, H. Michelina, H. Poulain, J.-P. Remadi, G. Touati, F. Trojette, E. Biagini, R. Di Bartolomeo, F.M. Ferlito, G. Marinelli, D. Pacini, F. Pasquale, C. Rapezzi, C. Savini, J. Boulif, G. El Khoury, B. Gerber, P. Noirhomme, D. Vancraeynest, F. Collard, G. Habib, D. Metras, A. Riberi, L. Tafanelli, F. Bursi, R. Lugli, F. Mantovani, C. Manicardi, M. Grazia, L. Bacchi-Reggiani, Lazam, Siham, Vanoverschelde, Jean-Loui, Tribouilloy, Christophe, Grigioni, Francesco, Suri, Rakesh M., Avierinos, Jean-Francoi, Meester, Christophe De, Barbieri, Andrea, Rusinaru, Dan, Russo, Antonio, Pasquet, Agnã¨, Michelena, Hector I., Huebner, Marianne, Maalouf, Joseph, Clavel, Marie-Annick, Szymanski, Catherine, Enriquez-Sarano, Maurice, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, Université Catholique de Louvain = Catholic University of Louvain (UCL), CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, University of Bologna/Università di Bologna, Cleveland Clinic, Aix Marseille Université (AMU), Università degli Studi di Modena e Reggio Emilia = University of Modena and Reggio Emilia (UNIMORE), Mayo Clinic [Rochester], and DESSAIVRE, Louise
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mitral valve ,Male ,Registrie ,medicine.medical_specialty ,Time Factors ,Time Factor ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,Treatment outcome ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Mitral valve ,Internal medicine ,Physiology (medical) ,medicine ,Humans ,Cardiac Surgical Procedure ,Prospective Studies ,Registries ,030212 general & internal medicine ,Cardiac Surgical Procedures ,Prospective cohort study ,Survival analysis ,Aged ,mitral valve insufficiency ,Mitral valve repair ,Mitral regurgitation ,business.industry ,Survival Analysis ,Surgery ,[SDV] Life Sciences [q-bio] ,Prospective Studie ,Editorial ,medicine.anatomical_structure ,Treatment Outcome ,Echocardiography ,Cardiology ,Female ,Survival Analysi ,business ,Cardiology and Cardiovascular Medicine ,Human - Abstract
Background: Mitral valve (MV) repair is preferred over replacement in clinical guidelines and is an important determinant of the indication for surgery in degenerative mitral regurgitation. However, the level of evidence supporting current recommendations is low, and recent data cast doubts on its validity in the current era. Accordingly, the aim of the present study was to analyze very long-term outcome after MV repair and replacement for degenerative mitral regurgitation with a flail leaflet. Methods: MIDA (Mitral Regurgitation International Database) is a multicenter registry enrolling patients with degenerative mitral regurgitation with a flail leaflet in 6 tertiary European and US centers. We analyzed the outcome after MV repair (n=1709) and replacement (n=213) overall, by propensity score matching, and by inverse probability-of-treatment weighting. Results: At baseline, patients undergoing MV repair were younger, had more comorbidities, and were more likely to present with a posterior leaflet prolapse than those undergoing MV replacement. After propensity score matching and inverse probability-of-treatment weighting, the 2 treatments groups were balanced, and absolute standardized differences were usually P P P P P Conclusions: Among patients with degenerative mitral regurgitation with a flail leaflet referred to mitral surgery, MV repair was associated with lower operative mortality, better long-term survival, and fewer valve-related complications compared with MV replacement.
- Published
- 2017
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