Mitral Valve Repair vs. Replacement by Different Etiologies - A Nationwide Population-Based Cohort Study
BACKGROUND: When mitral valve (MV) surgery is indicated, repair is preferred over replacement; however, this preference is not supported by evidence from clinical trials. Furthermore, the benefits of MV repair may not be universal for all etiologies of MV disease.Methods and Results: This study identified a total of 18,428 patients who underwent MV repair (n=4,817) or MV replacement (n=13,611) during 2001-2018 from Taiwan's National Health Insurance Research Database. These patients were classified into 4 etiologies: infective endocarditis (IE, n=2,678), rheumatic heart disease (RHD, n=4,524), ischemic mitral regurgitation (IMR, n=3,893), and degenerative mitral regurgitation (DMR, n=7,333). After propensity matching, all-cause mortality during follow-up was lower among patients receiving MV repair than among patients receiving MV replacement in the IE, IMR, and DMR groups (hazard ratio [HR]=0.72, 95% confidence interval [CI]: 0.55-0.93; HR=0.82, 95% CI: 0.73-0.92; and HR 0.73, 95% CI: 0.64-0.84, respectively). However, in the RHD group, the MV reoperation rate was higher after MV repair than after MV replacement (subdistribution HR=1.91, 95% CI: 1.02-3.55).
CONCLUSIONS: In comparison with MV replacement, MV repair was associated with a lower late mortality in patients with IE, IMR, and DMR, and a higher risk of reoperation in patients with RHD.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:88 |
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| Enthalten in: |
Circulation journal : official journal of the Japanese Circulation Society - 88(2024), 4 vom: 25. März, Seite 568-578 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lee, Hsiu-An [VerfasserIn] |
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| Links: |
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| Themen: |
Degenerative mitral regurgitation |
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| Anmerkungen: |
Date Completed 26.03.2024 Date Revised 26.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1253/circj.CJ-23-0640 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM367721775 |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: When mitral valve (MV) surgery is indicated, repair is preferred over replacement; however, this preference is not supported by evidence from clinical trials. Furthermore, the benefits of MV repair may not be universal for all etiologies of MV disease.Methods and Results: This study identified a total of 18,428 patients who underwent MV repair (n=4,817) or MV replacement (n=13,611) during 2001-2018 from Taiwan's National Health Insurance Research Database. These patients were classified into 4 etiologies: infective endocarditis (IE, n=2,678), rheumatic heart disease (RHD, n=4,524), ischemic mitral regurgitation (IMR, n=3,893), and degenerative mitral regurgitation (DMR, n=7,333). After propensity matching, all-cause mortality during follow-up was lower among patients receiving MV repair than among patients receiving MV replacement in the IE, IMR, and DMR groups (hazard ratio [HR]=0.72, 95% confidence interval [CI]: 0.55-0.93; HR=0.82, 95% CI: 0.73-0.92; and HR 0.73, 95% CI: 0.64-0.84, respectively). However, in the RHD group, the MV reoperation rate was higher after MV repair than after MV replacement (subdistribution HR=1.91, 95% CI: 1.02-3.55) | ||
| 520 | |a CONCLUSIONS: In comparison with MV replacement, MV repair was associated with a lower late mortality in patients with IE, IMR, and DMR, and a higher risk of reoperation in patients with RHD | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Degenerative mitral regurgitation | |
| 650 | 4 | |a Infective endocarditis | |
| 650 | 4 | |a Ischemic mitral regurgitation | |
| 650 | 4 | |a Mitral valve repair | |
| 650 | 4 | |a Rheumatic heart disease | |
| 700 | 1 | |a Chang, Feng-Cheng |e verfasserin |4 aut | |
| 700 | 1 | |a Yeh, Jih-Kai |e verfasserin |4 aut | |
| 700 | 1 | |a Tung, Ying-Chang |e verfasserin |4 aut | |
| 700 | 1 | |a Wu, Victor Chien-Chia |e verfasserin |4 aut | |
| 700 | 1 | |a Hsieh, Ming-Jer |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Chun-Yu |e verfasserin |4 aut | |
| 700 | 1 | |a Yeh, Chi-Hsiao |e verfasserin |4 aut | |
| 700 | 1 | |a Chu, Pao-Hsien |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Shao-Wei |e verfasserin |4 aut | |
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