Repair versus replacement for ischemic mitral regurgitation

Ischemic mitral regurgitation (MR) following myocardial infarction is common and presages a doubling in mortality for those with at least mild regurgitation. The disorder reflects disease of the myocardium, rather than an abnormality of the valve itself. Surgical practice guidelines support intervention for severe symptomatic ischemic MR, but evidence is lacking to inform whether valvular repair or replacement is the superior surgical approach.

In this multicentre study, a total of 251 patients with severe ischemic MR were randomized to either mitral valve repair or chordal sparing replacement with concomitant revascularization as required. The primary end-point was the left ventricular end-systolic volume index (LVESVI) at 12 months, a parameter which is closely associated with long term outcomes. At 12 months, there was no significant difference in LVESI between patients treated with repair (54.6±25.0 mL per square meter) and replacement (60.7±31.5 mL per square meter). There was also no difference in mortality (14.3% vs. 17.6%, hazard ratio 0.79; 95% confidence interval, 0.42 to 1.47; P=0.45), major …