title: Mitral valve replacement versus annuloplasty for treating severe functional mitral regurgitation.
abstract: OBJECTIVE
  To improve the clinical outcome of patients with severe functional mitral regurgitation (FMR) associated with ischemic cardiomyopathy (ICM), we compared the therapeutic efficacy of mitral annuloplasty (MAP) with that of mitral valve replacement (MVR).
  
  
  METHODS
  In a retrospective observation 63 consecutive patients underwent mitral valve surgery for severe ICM-FMR from November 1999 to March 2012. All patients had severe FMR (regurgitant volume >60 ml/beat) with Carpentier type I and type IIIb disease. Mean RV was 74.0 ± 35.0 ml/beat and coaptation depth was 12.7 ± 3.0 mm. Twenty-six patients (41.3 %) were treated by MVR with sparing of the subvalvular apparatus and 37 (58.7 %) by MAP.
  
  
  RESULTS
  Total in-hospital mortality was 6.3 %. Kaplan-Meier survival estimates at 1 and 5 years were 84.2 and 78.6 % in the MVR group and 82.6 and 71.6 % in the MAP group, with no significant difference between groups (p = 0.758). Freedom from major adverse cardiac and cerebrovascular events (MACCE) at 5 years was 66.9 % for patients treated by MVR and 64.1 % for those treated by MAP (p = 0.866). At the last follow-up visit, >grade II MR had recurred in 4 annuloplasty patients (10.8 %). In multivariate analysis, independent predictors of increased late death and MACCE were significantly associated with residual pulmonary hypertension (late death: odds ratio = 25.0, p = 0.0009; MACCE: odds ratio = 31.3, p = 0.0001).
  
  
  CONCLUSIONS
  Mitral valve replacement with sparing of the subvalvular apparatus is a safe and effective surgical alternative for patients with severe FMR.
authors.affiliation: Department of Cardiovascular Surgery, Nishinomiya Watanabe Cardiovascular Center, 3-25, Ikeda-cho, Nishinomiya-shi, 662-0911, Japan, kazuy_nwcc@bca.bai.ne.jp.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Yoshida
authors.forename: Kenji
authors.initials: K
authors.lastname: Okada
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Miyahara
authors.forename: Atsushi
authors.initials: A
authors.lastname: Omura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Inoue
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Minami
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Okita
mesh_terms: D000368:Aged; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D058386:Mitral Valve Annuloplasty; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000601:surgery*; D015999:Multivariate Analysis; D012008:Recurrence; D018487:Ventricular Dysfunction, Left / Q000209:etiology