caa a22 4500 397495951 CHVBK 20180308164521.0 cr unu---uuuuu 161202e199510 xx s 000 0 eng 10.1016/S1010-7940(05)80008-9 doi (NATIONALLICENCE)oxford-10.1016/S1010-7940(05)80008-9 The effect of pathophysiology on the surgical treatment of ischemicmitral regurgitation: operative and late risks of repair versusreplacement [Elektronische Daten] Operative correction of ischemic mitral regurgitation (IMR) isassociated with high risk approach. The objective of this retrospectivestudy was to examine the interaction between the various underlyingpathophysiologic mechanisms, the operative procedure, and their influenceon short- and long-term outcomes. Over a 10-year period starting January1984, mitral valve repair or replacement was performed on 150 patients withIMR. The age range was 42-86, mean 67, years; 71 (47%) were females; 139(93%) were in NYHA functional class III or IV; 23 (15%) were reoperations;and 30 (20%) were in atrial fibrillation. Functional IMR due to annulardilatation or restrictive leaflet motion was present in 106 (71%), andstructural IMR due to ruptured chordae or papillary muscle in 44 (29%).Mitral valve repair was performed in 94 (63%) with an annuloplasty ringemployed in 80 (85%) patients. Mitral valve replacement was performed in 56(37%), with 40 (71%) receiving a bioprosthesis (32 Hancock and 8Carpentier-Edwards valves) and 16 (29%) a St. Jude valve. Coronary arterybypass graft surgery was performed in 139 (93%) patients. The overalloperative mortality (OM) was 14/150 (9.3%). The OM for repair was 9.5%compared to 8.9% for replacement (P = NS). There was higher OM in theelderly, particularly in the repair group (P = 0.053), and a trend towardsreduced OM in the recent years of the study (P = NS). No predictors of OMwere identified by multivariate logistic regression analysis. Long-termfollow-up was 98% complete and ranged from 2-120, mean 31.2, months for atotal of 935 patient-years. The overall 5-year survival rate was 71 +/- 6%,with 91 +/- 5% for the replacement group compared to 56% +/- 10% for therepair group (P = 0.01). The functional subset of IMR who had a repair hadthe worse long-term survival (43 +/- 13%) compared to the structural/repair(76 +/- 13%) and structural/replacement groups (89 +/- 8%), and 92 +/- 7%for the functional/replacement group ((P = 0.0049). Multivariate logisticregression analysis identified the functional/repair group (hazards ratio4.4; +/- 95%, confidence interval 1.6, 11, (P = 0.0031); and earlier yearsof surgery (hazards ratio 4.7; +/- 95% confidence interval 1.021; (P =0.046) to be predictors of worse long-term survival. These results suggestthat, in IMR, the underlying responsible pathophysiologic mechanisms appearto be the major determinants of survival, rather than the choice of theoperative procedure. © Springer-Verlag European Journal of Cardio-Thoracic Surgery Elsevier Science B.V. 9/10(1995-10), 568-574 1010-7940 9:10<568 1995 9 ejcts https://doi.org/10.1016/S1010-7940(05)80008-9 text/html Onlinezugriff via DOI 1 abstract jats NATIONALLICENCE 856 40 https://doi.org/10.1016/S1010-7940(05)80008-9 text/html Onlinezugriff via DOI NATIONALLICENCE 773 0- European Journal of Cardio-Thoracic Surgery Elsevier Science B.V 9/10(1995-10), 568-574 1010-7940 9:10<568 1995 9 ejcts Metadata rights reserved CC BY-NC-4.0 http://creativecommons.org/licenses/by-nc/4.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-oxford