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AHA: Both Repair, Replacement Benefit Mitral Regurgitation

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AHA: Both Repair, Replacement Benefit Mitral Regurgitation

No difference in left ventricular end-systolic volume index, rate of death between the groups

MONDAY, Nov. 18, 2013 (HealthDay News) -- For patients with severe ischemic mitral regurgitation, clinical outcomes are similar for those who undergo mitral-valve repair or chordal-sparing replacement, according to a study published online Nov. 18 in the New England Journal of Medicine. The research was published to coincide with the American Heart Association's 2013 Scientific Sessions, held from Nov. 16 to 19 in Dallas.

Michael A. Acker, M.D., from the University of Pennsylvania School of Medicine in Philadelphia, and colleagues randomized 251 patients with severe ischemic mitral regurgitation to undergo mitral-valve repair or chordal-sparing replacement.

The researchers found that the left ventricular end-systolic volume index (LVESVI) was 54.6 ± 25.0 ml and 60.7 ± 31.5 ml per square meter body-surface area in the repair and replacement groups, respectively, at 12 months. The rate of death was not significantly different between the groups (14.3 and 17.6 percent, respectively; hazard ratio with repair, 0.79; P = 0.45 by the log-rank test). After adjustment for death, there was no significant difference in LVESVI (z score, 1.33; P = 0.18). At 12 months, the rate of moderate or severe recurrence of mitral regurgitation was significantly higher in the repair group (32.6 percent) than in the replacement group (2.3 percent) (P < 0.001). At 12 months, there were no significant differences between the groups in the rate of a composite of major adverse cardiac or cerebrovascular events, in functional status, or quality of life.

"Further patient follow-up is needed to confirm the findings of this trial," the authors write.

Abstract (http://www.nejm.org/doi/full/10.1056/NEJMoa1312808?query=featured_home#t=abstract )Full Text (http://www.nejm.org/doi/full/10.1056/NEJMoa1312808?query=featured_home#t=article )More Information (http://my.americanheart.org/professional/Sessions/ScientificSessions/Scientific-Sessions_UCM_316900_SubHomePage.jsp )