DALLAS, Nov.18, 2013 — People who had leaky mitral heart valves replaced because of severe ischemic mitral regurgitation fared about the same as those who had them repaired, according to a late-breaking clinical trial presented at the American Heart Association’s Scientific Sessions 2013.
The mitral valve controls blood from the heart’s upper left to lower left chambers, allowing blood to flow one direction through the heart and into the body.
Leaking mitral valves, often a complication from heart attack, allow blood to flow back into the heart’s upper left chamber — a condition known as ischemic mitral regurgitation. Consequences range from mild to severe, including heart failure or serious rhythm problems called arrhythmias.
“Practice guidelines recommend repairing or replacing mitral valves in severe cases, but there has been a lack of conclusive evidence that one approach is better than the other,” said Michael Acker, M.D., the William Maul Measey Professor of Surgery in the University of Pennsylvania’s Perelman School of Medicine and a clinical investigator with the Cardiothoracic Surgical Trials Network (CTSN).
While repair or replacement resulted in similar survival rates and addressed harmful structural changes in the left ventricle, repaired valves were more likely to leak again.
The CTSN Severe MR randomized trial was a two-year study of 251 patients with severe ischemic mitral valve regurgitation in 22 U.S. clinical centers. It compared 125 patients who underwent valve replacement to 126 who had their faulty valve repaired.
The study found:
“I think there is a bias in favor of valve repair versus replacement, so this information should be very helpful for cardiologists and surgeons in choosing an appropriate approach for this growing patient population,” Acker said.
Co-authors are: Michael K. Parides, Ph.D.; Louis P. Perrault, M.D.; Alan J. Moskowitz, M.D.; Annetine C. Gelijns, Ph.D.; Pierre Voisine, M.D.; Peter K. Smith, M.D.; Judy W. Hung, M.D.; Eugene Blackstone, M.D.; John D. Puskas, M.D.; Michael Argenziano, M.D.; James S. Gammie, M.D., Michael Mack, M.D., Deborah D. Ascheim, M.D., Emilia Bagiella, Ph.D., Ellen Moquete, R.N.; Bruce Ferguson, M.D.; Keith Horvath, M.D.; Nancy L. Geller Ph.D.; Marissa A. Miller, DVM.; Joseph Y. Woo, M.D.; David A D’Alessandro, M.D.; Gorav Ailawadi, M.D.; Francois Dagenais, M.D.; Timothy J. Gardner, M.D.; Patrick T. O’Gara, M.D.; Robert Michler, M.D.; Irving L. Kron, M.D., Disclosures
The CTSN is funded by the National Heart, Lung, and Blood Institute, the National Institute for Neurological Diseases and Stroke, and the Canadian Institutes for Health Research and InCHOIR, Icahn School of Medicine at Mount Sinai, served as the CTSN Coordinating Center.
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Note: Actual presentation is 11:29 a.m. CT/12:29 p.m. ET Monday, Nov. 18, 2013 in Hall E.