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Maurice Enriquezsarano - One of the best experts on this subject based on the ideXlab platform.

  • concomitant Mitral Regurgitation in patients with chronic aortic Regurgitation
    Journal of the American College of Cardiology, 2020
    Co-Authors: Li Tan Yang, Maurice Enriquezsarano, Christopher G Scott, Ratnasari Padang, Joseph F Maalouf, Patricia A Pellikka, Hector I Michelena
    Abstract:

    Abstract Background Etiology, mechanisms, and survival of Mitral Regurgitation (MR) plus hemodynamically-significant chronic aortic Regurgitation (AR) are mostly unknown. Objectives The purpose of ...

  • outcome and undertreatment of Mitral Regurgitation a community cohort study
    The Lancet, 2018
    Co-Authors: Volha Dziadzko, Marieannick Clavel, Joseph F Maalouf, Hector I Michelena, Vuyisile T Nkomo, Mikhail A Dziadzko, Jose R Medinainojosa, Prabin Thapa, Maurice Enriquezsarano
    Abstract:

    Summary Background Mitral Regurgitation is the most common valve disease worldwide but whether the community-wide prevalence, poor patient outcomes, and low rates of surgical treatment justify costly development of new therapeutic interventions remains uncertain. Therefore, we did an observational cohort study to assess the clinical characteristics, outcomes, and degree of undertreatment of Mitral Regurgitation in a community setting. Methods We used data from Mayo Clinic electronic health records and the Rochester Epidemiology Project to identify all cases of moderate or severe isolated single-valvular Mitral Regurgitation (with no other severe left-sided valvular disease or previous Mitral surgery) diagnosed during a 10-year period in the community setting in Olmsted County (MN, USA). We assessed clinical characteristics, mortality, heart failure incidence, and results of cardiac surgery post-diagnosis. Findings Between Jan 1, 2000, and Dec 31, 2010, 1294 community residents (median age at diagnosis 77 years [IQR 66–84]) were diagnosed with moderate or severe Mitral Regurgitation by Doppler echocardiography (prevalence 0·46% [95% CI 0·42–0·49] overall; 0·59% [0·54–0·64] in adults). Left-ventricular ejection fraction below 50% was frequent (recorded in 538 [42%] patients), and these patients had a slightly lower regurgitant volume than those with an ejection fraction of 50% or higher (mean 39 mL [SD 16] vs 45 mL [21], p Interpretation In the community, isolated Mitral Regurgitation is common and is associated with excess mortality and frequent heart failure postdiagnosis in all patient subsets, even in those with normal left-ventricular ejection fraction and low comorbidity. Despite these poor outcomes, only a minority of affected patients undergo Mitral (or any type of cardiac) surgery even in a community with all means of diagnosis and treatment readily available and accessible. This suggests that in a wider population there might be a substantial unmet need for treatment for this disorder. Funding Mayo Clinic Foundation.

  • Mitral Regurgitation surgery in patients with ischemic cardiomyopathy and ischemic Mitral Regurgitation factors that influence survival
    The Journal of Thoracic and Cardiovascular Surgery, 2011
    Co-Authors: Simon Maltais, Hartzell V Schaff, Richard C Daly, Rakesh M Suri, Joseph A Dearani, Yan Topilsky, Thoralf M Sundt, Maurice Enriquezsarano, Soon J Park
    Abstract:

    Objective The treatment of patients with ischemic cardiomyopathy and concomitant Mitral Regurgitation can be challenging and is associated with reduced long-term survival. It is unclear how Mitral valve repair versus replacement affects subsequent outcome. Therefore, we conducted this study to understand the predictors of mortality and to delineate the role of Mitral valve repair versus replacement in this high-risk population. Methods From 1993 to 2007, 431 patients (mean age, 70 ± 9 years) with ischemic cardiomyopathy (left ventricular ejection fraction ≤ 45%) and significant ischemic Mitral Regurgitation (>2) were identified. Patients (44) with concomitant Mitral stenosis were excluded from the analysis. A homogeneous group of 387 patients underwent combined coronary artery bypass grafting and Mitral valve surgery, Mitral valve repair in 302 (78%) and Mitral valve replacement in 85 (22%). Uni- and multivariate analyses were performed on the entire cohort, and the predictors of mortality were identified in 2 distinct risk phases. Furthermore, we specifically examined the impact of Mitral valve repair versus replacement by comparing 2 propensity-matched subgroups. Results Follow-up was 100% complete (median, 3.6 years; range, 0–15 years). Overall 1-, 5-, and 10-year survivals were 82.7%, 55.2%, and 24.3%, respectively, for the entire group. The risk factors for an increased mortality within the first year of surgery included previous coronary artery bypass grafting (hazard ratio = 3.39; P P  = .007), age (hazard ratio = 1.5; P  = .03), and low left ventricular ejection fraction (hazard ratio = 1.31; P  = .026). Thereafter, only age (hazard ratio = 1.58; P P  = .001), and preoperative renal insufficiency (hazard ratio = 1.72; P  = .025) were predictive. The status of Mitral valve repair versus replacement did not influence survival, and this was confirmed by comparable survival in propensity-matched analyses. Conclusions Survival after combined coronary artery bypass grafting and Mitral valve surgery in patients with ischemic cardiomyopathy (left ventricular ejection fraction ≤ 45%) and Mitral Regurgitation is compromised and mostly influenced by factors related to the patient's condition at the time of surgery. The specifics of Mitral valve repair versus replacement did not seem to affect survival.

  • impact of left atrial volume on clinical outcome in organic Mitral Regurgitation
    Journal of the American College of Cardiology, 2010
    Co-Authors: Thierry Le Tourneau, Rakesh M Suri, Yan Topilsky, Delphine Detaint, D Messikazeitoun, Antonio Russo, Douglas W Mahoney, Maurice Enriquezsarano
    Abstract:

    Objectives: The purpose of this paper was to assess the link between left atrial (LA) volume at diagnosis and outcome of patients with Mitral Regurgitation (MR).Background: Left atrial enlargement ...

  • quantitative determinants of the outcome of asymptomatic Mitral Regurgitation
    The New England Journal of Medicine, 2005
    Co-Authors: Maurice Enriquezsarano, Hartzell V Schaff, Christopher G Scott, J F Avierinos, David Messikazeitoun, Delphine Detaint, Vuyisile T Nkomo, Jamil A Tajik
    Abstract:

    background The clinical outcome of asymptomatic Mitral Regurgitation is poorly defined, and the treatment is uncertain. We studied the effect on the outcome of quantifying Mitral Regurgitation according to recent guidelines. methods We prospectively enrolled 456 patients (mean [±SD] age, 63±14 years; 63 percent men; ejection fraction, 70±8 percent) with asymptomatic organic Mitral Regurgitation, quantified according to current recommendations (regurgitant volume, 66±40 ml per beat; effective regurgitant orifice, 40±27 mm 2 ). results The estimated five-year rates (±SE) of death from any cause, death from cardiac causes, and cardiac events (death from cardiac causes, heart failure, or new atrial fibrillation) with medical management were 22±3 percent, 14±3 percent, and 33±3 percent, respectively. Independent determinants of survival were increasing age, the presence of diabetes, and increasing effective regurgitant orifice (adjusted risk ratio per 10-mm 2 increment, 1.18; 95 percent confidence interval, 1.06 to 1.30; P<0.01), the predictive power of which superseded all other qualitative and quantitative measures of Regurgitation. Patients with an effective regurgitant orifice of at least 40 mm 2 had a five-year survival rate that was lower than expected on the basis of U.S. Census data (58±9 percent vs. 78 percent, P=0.03). As compared with patients with a regurgitant orifice of less than 20 mm 2 , those with an orifice of at least 40 mm 2 had an increased risk of death from any cause (adjusted risk ratio, 2.90; 95 percent confidence interval, 1.33 to 6.32; P<0.01), death from cardiac causes (adjusted risk ratio, 5.21; 95 percent confidence interval, 1.98 to 14.40; P<0.01), and cardiac events (adjusted risk ratio, 5.66; 95 percent confidence interval, 3.07 to 10.56; P<0.01). Cardiac surgery was ultimately performed in 232 patients and was independently associated with improved survival (adjusted risk ratio, 0.28; 95 percent confidence interval, 0.14 to 0.55; P<0.01). conclusions Quantitative grading of Mitral Regurgitation is a powerful predictor of the clinical outcome of asymptomatic Mitral Regurgitation. Patients with an effective regurgitant orifice of at least 40 mm 2 should promptly be considered for cardiac surgery.

Robert E Michler - One of the best experts on this subject based on the ideXlab platform.

  • the choice of treatment in ischemic Mitral Regurgitation with reduced left ventricular function
    The Annals of Thoracic Surgery, 2019
    Co-Authors: Francesco Nappi, Sanjeet Singh Avtaar Singh, Muralidhar Padala, David Attias, Mohammed Nejjari, Christos G Mihos, Umberto Benedetto, Robert E Michler
    Abstract:

    Background Ischemic Mitral Regurgitation is a condition characterized by Mitral insufficiency secondary to an ischemic left ventricle. Primarily, the pathology is the result of perturbation of normal regional left ventricular geometry combined with adverse remodeling. We present a comprehensive review of contemporary surgical, medical, and percutaneous treatment options for ischemic Mitral Regurgitation, rigorously examined by current guidelines and literature. Methods We conducted a literature search of the PubMed database, Embase, and the Cochrane Library (through November 2018) for studies reporting perioperative or late mortality and echocardiographic outcomes after surgical and nonsurgical intervention for ischemic Mitral Regurgitation. Results Treatment of this condition is challenging and often requires a multimodality approach. These patients usually have multiple comorbidities that may preclude surgery as a viable option. A multidisciplinary team discussion is crucial in optimizing outcomes. There are several options for treatment and management of ischemic Mitral Regurgitation with differing benefits and risks. Guideline-directed medical therapy for heart failure is the treatment choice for moderate and severe ischemic Mitral Regurgitation, with consideration of coronary revascularization, Mitral valve surgery, cardiac resynchronization therapy, or a combination of these, in appropriate candidates. The use of transcatheter Mitral valve therapy is considered appropriate in high-risk patients with severe ischemic Mitral Regurgitation, heart failure, and reduced left ventricular ejection fraction, especially in those with hemodynamic instability. Conclusions The role of Mitral valve surgery and transcatheter Mitral valve therapy continues to evolve.

  • two year outcomes of surgical treatment of moderate ischemic Mitral Regurgitation
    The New England Journal of Medicine, 2016
    Co-Authors: Robert E Michler, Michael A. Acker, Judy Hung, Alan J Moskowitz, Peter K Smith, Michael K Parides, Gorav Ailawadi, Vinod H Thourani, Helena L Chang, Louis P Perrault
    Abstract:

    BackgroundIn a trial comparing coronary-artery bypass grafting (CABG) alone with CABG plus Mitral-valve repair in patients with moderate ischemic Mitral Regurgitation, we found no significant difference in the left ventricular end-systolic volume index (LVESVI) or survival after 1 year. Concomitant Mitral-valve repair was associated with a reduced prevalence of moderate or severe Mitral Regurgitation, but patients had more adverse events. We now report 2-year outcomes. MethodsWe randomly assigned 301 patients to undergo either CABG alone or the combined procedure. Patients were followed for 2 years for clinical and echocardiographic outcomes. ResultsAt 2 years, the mean (±SD) LVESVI was 41.2±20.0 ml per square meter of body-surface area in the CABG-alone group and 43.2±20.6 ml per square meter in the combined-procedure group (mean improvement over baseline, −14.1 ml per square meter and −14.6 ml per square meter, respectively). The rate of death was 10.6% in the CABG-alone group and 10.0% in the combined-...

  • two year outcomes of surgical treatment of severe ischemic Mitral Regurgitation
    The New England Journal of Medicine, 2016
    Co-Authors: Robert E Michler, Michael A. Acker, Judy Hung, Alan J Moskowitz, Michael K Parides, Gorav Ailawadi, Vinod H Thourani, Helena L Chang, Pete Smith, Louis P Perrault
    Abstract:

    BackgroundIn a trial comparing coronary-artery bypass grafting (CABG) alone with CABG plus Mitral-valve repair in patients with moderate ischemic Mitral Regurgitation, we found no significant difference in the left ventricular end-systolic volume index (LVESVI) or survival after 1 year. Concomitant Mitral-valve repair was associated with a reduced prevalence of moderate or severe Mitral Regurgitation, but patients had more adverse events. We now report 2-year outcomes. MethodsWe randomly assigned 301 patients to undergo either CABG alone or the combined procedure. Patients were followed for 2 years for clinical and echocardiographic outcomes. ResultsAt 2 years, the mean (±SD) LVESVI was 41.2±20.0 ml per square meter of body-surface area in the CABG-alone group and 43.2±20.6 ml per square meter in the combined-procedure group (mean improvement over baseline, −14.1 ml per square meter and −14.6 ml per square meter, respectively). The rate of death was 10.6% in the CABG-alone group and 10.0% in the combined-...

  • predicting recurrent Mitral Regurgitation after Mitral valve repair for severe ischemic Mitral Regurgitation
    The Journal of Thoracic and Cardiovascular Surgery, 2015
    Co-Authors: Irving L. Kron, Judy Hung, Jessica Overbey, Denis Bouchard, Annetine C Gelijns, Alan J Moskowitz, Pierre Voisine, Patrick T Ogara, Michael Argenziano, Robert E Michler
    Abstract:

    Abstract Objectives The Cardiothoracic Surgical Trials Network recently reported no difference in the primary end point of left ventricular end-systolic volume index at 1 year postsurgery in patients randomized to repair (n = 126) or replacement (n = 125) for severe ischemic Mitral Regurgitation. However, patients undergoing repair experienced significantly more recurrent Mitral Regurgitation than patients undergoing replacement (32.6% vs 2.3%). We examined whether baseline echocardiographic and clinical characteristics could identify those who will develop moderate/severe recurrent Mitral Regurgitation or die. Methods Our analysis includes 116 patients who were randomized to and received Mitral valve repair. Logistic regression was used to estimate a model-based probability of recurrence or death from baseline factors. Receiver operating characteristic curves were constructed from these estimated probabilities to determine classification cut-points maximizing accuracy of prediction based on sensitivity and specificity. Results Of the 116 patients, 6 received a replacement before leaving the operating room; all other patients had mild or less Mitral Regurgitation on intraoperative echocardiogram after repair. During the 2-year follow-up period, 76 patients developed moderate/severe Mitral Regurgitation or died (53 Mitral Regurgitation recurrences, 13 Mitral Regurgitation recurrences and death, and 10 deaths). The mechanism for recurrent Mitral Regurgitation was largely Mitral valve leaflet tethering. Our model (including age, body mass index, sex, race, effective regurgitant orifice area, basal aneurysm/dyskinesis, New York Heart Association class, history of coronary artery bypass grafting, percutaneous coronary intervention, or ventricular arrhythmias) yielded an area under the receiver operating characteristic curve of 0.82. Conclusions The model demonstrated good discrimination in identifying patients who will survive 2 years without recurrent Mitral Regurgitation after Mitral valve repair. Although our results require validation, they offer a clinically relevant risk score for selection of surgical candidates for this procedure.

Patrick M Mccarthy - One of the best experts on this subject based on the ideXlab platform.

  • a multiparameter algorithm to guide repair of degenerative Mitral Regurgitation
    The Journal of Thoracic and Cardiovascular Surgery, 2020
    Co-Authors: Patrick M Mccarthy, Joshua C Herborn, Jane Kruse, Menghan Liu, Adin Cristian Andrei, James D Thomas
    Abstract:

    Abstract Purpose Degenerative Mitral Regurgitation repair using a measured algorithm could increase the precision and reproducibility of repair outcomes. Methods Direct and echocardiographic measurements guide the repair to achieve a coaptation length of 5 to 10 mm and minimize the risk of systolic anterior motion. Leaflet reconstruction restored the normal 2 to 1 ratio of anterior to posterior leaflet length without residual prolapse or restriction. The choice of ring size was based on anterior leaflet length, the distance from the leaflet coaptation point to the septum, and the anterior-posterior ring dimension. Freedom from reoperation and Mitral Regurgitation recurrence were based on multistate models. Results One thousand fifty-one patients had Mitral surgery and 1026 (97.6%) were repaired. A2 length was 27.2 ± 4.5 mm; and the reconstructed posterior leaflet was 13.9 ± 2.3 mm. Median ring size was 34 mm and strongly correlated to A2 length (R = 0.76; P  Conclusions A simple, reproducible, measured algorithm for degenerative Mitral valve repair provides excellent early and late results and is a useful adjunct to established surgical techniques.

  • annular geometry and motion in human ischemic Mitral Regurgitation novel assessment with three dimensional echocardiography and computer reconstruction
    The Annals of Thoracic Surgery, 2004
    Co-Authors: Rashid M Ahmad, Takahiro Shiota, Marc A Gillinov, Patrick M Mccarthy, Eugene H Blackstone, Carolyn Appersonhansen, Jian Xin Qin, Deborah A Agler, Delos M Cosgrove
    Abstract:

    Background Annular geometry and motion in functional ischemic Mitral Regurgitation are incompletely understood. Three-dimensional echocardiography demonstrates saddle-shaped annular geometry, but standard methodology does not enable quantification of annular motion. Therefore, a novel technique using three-dimensional echocardiography and computer software was used to characterize alterations in Mitral annular geometry and motion in patients with ischemic Mitral Regurgitation. Methods We developed a computer program to reconstruct the Mitral annulus based on spatial coordinates from three-dimensional echocardiography. Data were obtained at end-diastole and end-systole in 7 patients with ischemic Mitral Regurgitation and 5 normal control subjects. Mitral annular motion was quantified by calculating the displacement area of the annulus between end-diastole and end-systole. Results Comparison of ischemic Mitral Regurgitation and control patients revealed differences in annular geometry and motion at end-diastole. Annular perimeter was greater in ischemic Mitral Regurgitation patients (10.7 ± 0.7 cm versus 8.6 ± 0.2 cm in control group; p p 2 versus 5.7 ± 0.3 cm 2 ; p 2 versus 8.7 ± 1.1 cm 2 ; p Conclusions Computer analysis of data obtained from three-dimensional echocardiography demonstrates altered annular geometry and motion in patients with ischemic Mitral Regurgitation. Patients with ischemic Mitral Regurgitation have annular dilatation, with an increase in anterior and posterior annular perimeters; this is accompanied by an increase in the intertrigonal distance and restriction of annular motion.

  • Recurrent Mitral Regurgitation after annuloplasty for functional ischemic Mitral Regurgitation
    The Journal of thoracic and cardiovascular surgery, 2004
    Co-Authors: Edwin C. Mcgee, A. Marc Gillinov, Takahiro Shiota, Eugene H Blackstone, Bruce W Lytle, Joseph F Sabik, Jeevanantham Rajeswaran, Gideon Cohen, Farzad Najam, Patrick M Mccarthy
    Abstract:

    Objectives We sought to characterize the temporal return of Mitral Regurgitation after annuloplasty for functional ischemic Mitral Regurgitation; to identify its predictors, particularly with respect to annuloplasty type; and to determine whether annuloplasty type influences survival. Methods From April 1985 through November 2002, 585 patients underwent annuloplasty alone for repair of functional ischemic Mitral Regurgitation, generally with concomitant coronary revascularization (95%). A flexible band (Cosgrove) was used in 68%, a rigid ring (Carpentier) in 21%, and bovine pericardial annuloplasty (Peri-Guard) in 11%. Six hundred seventy-eight postoperative echocardiograms were available in 422 patients to assess the time course of postoperative Mitral Regurgitation and its correlates. Most echocardiograms were performed early after the operation (median, 8 days); 17% were performed at 1 year or beyond. Results During the first 6 months after repair, the proportion of patients with 0 or 1+ Mitral Regurgitation decreased from 71% to 41%, whereas the proportion with 3+ or 4+ Regurgitation increased from 13% to 28% ( P P = .2), although Cosgrove bands were used in most patients receiving 26- and 28-mm annuloplasties. Freedom from reoperation was 97% at 5 years. Annuloplasty type was not associated with survival. Conclusions Although initial Mitral valve replacement would eliminate the risk of postoperative Mitral Regurgitation, this strategy has been associated with reduced survival. Therefore the development of additional techniques is necessary to achieve more secure repair of functional ischemic Mitral Regurgitation.

  • is repair preferable to replacement for ischemic Mitral Regurgitation
    The Journal of Thoracic and Cardiovascular Surgery, 2001
    Co-Authors: Marc A Gillinov, Per Wierup, Eugene H Blackstone, Delos M Cosgrove, Bruce W Lytle, Ehab Bishay, Jennifer A White, Patrick M Mccarthy
    Abstract:

    Abstract Objective: This study was undertaken to compare Mitral valve repair and replacement as treatments for ischemic Mitral Regurgitation. Methods: From 1985 through 1997, a total of 482 patients with ischemic Mitral Regurgitation underwent either valve repair (n = 397) or valve replacement (n = 85). Patients more likely ( P ≤.01) to undergo repair had functional Mitral Regurgitation or coronary revascularization with an internal thoracic artery graft; those more likely to receive valve replacement were in higher New York Heart Association functional classes or underwent emergency operations. These factors were used for multivariable propensity matching. Risk factors for early and late death were identified by multivariable, multiphase hazard function analysis. Results: Within the propensity-matched better-risk group, survivals after valve replacement were 81%, 56%, and 36% at 30 days, 1 year, and 5 years, but survivals after repair were 94%, 82%, and 58% at these intervals ( P =.08). In contrast, within the poor-risk group, survivals after repair and replacement were similar ( P =.4). Risk factors ( P ≤.01) included older age, higher functional class, greater wall motion abnormality, and renal dysfunction. Approximately 70% of patients were predicted to benefit from repair; the benefit lessened or was negated if an internal thoracic artery graft was not used, if a lateral wall motion abnormality was present, or if the Mitral Regurgitation jet pattern was complex. Freedom from repair failure at 5 years was 91%. Conclusion: Late survival is poor after surgery for ischemic Mitral Regurgitation. Most patients with ischemic Mitral Regurgitation benefit from Mitral valve repair. In the most complex, high-risk settings, survivals after repair and replacement are similar.

Alan J Moskowitz - One of the best experts on this subject based on the ideXlab platform.

  • transcatheter Mitral valve repair for functional Mitral Regurgitation evaluating the evidence
    The Journal of Thoracic and Cardiovascular Surgery, 2020
    Co-Authors: Annetine C Gelijns, Judy Hung, Alan J Moskowitz, Patrick T Ogara, Gorav Ailawadi, Gennaro Giustino, Michael J Mack, Donna Mancini, Emilia Bagiella, Martin B Leon
    Abstract:

    Abstract Objectives Two trials (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation Trial and Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation Trial) were published in 2018 evaluating the effectiveness and safety of transcatheter repair for patients with heart failure with significant functional Mitral Regurgitation, which yielded different results. This article reviews the strength of the evidence, differences in trial designs, ethical and implementation implications, and delineates future research needs to help guide the appropriate dissemination of transcatheter repair for functional patients with Mitral Regurgitation. Methods The National Heart, Lung, and Blood Institute convened a workshop of interdisciplinary experts to address these objectives. Results Transcatheter repair of functional Mitral Regurgitation can provide significant benefits in terms of heart failure hospitalizations, survival, and quality of life when appropriate heart failure candidates with moderate to severe or severe Mitral Regurgitation while on optimal guideline-directed medical therapy can be identified. Key ingredients for success are preoperative evaluation and management and postoperative care by an interdisciplinary heart team. Conclusions Given the discordance observed between trials, ongoing innovation in patient management, and potential expansion of indications for use, the evidence base must be expanded to optimize appropriate implementation of this complex therapy. This will require more complete capture of outcome data in real-world settings for all eligible candidates whether or not they receive this therapy. Inevitably, the indications for use of this therapy will expand, as will the devices and therapeutic approaches for this population, necessitating the study of comparative effectiveness through randomized trials or observational studies. Moreover, given the substantial variations in care delivery, conducting implementation research to delineate characteristics of the optimal care model would be of benefit.

  • two year outcomes of surgical treatment of moderate ischemic Mitral Regurgitation
    The New England Journal of Medicine, 2016
    Co-Authors: Robert E Michler, Michael A. Acker, Judy Hung, Alan J Moskowitz, Peter K Smith, Michael K Parides, Gorav Ailawadi, Vinod H Thourani, Helena L Chang, Louis P Perrault
    Abstract:

    BackgroundIn a trial comparing coronary-artery bypass grafting (CABG) alone with CABG plus Mitral-valve repair in patients with moderate ischemic Mitral Regurgitation, we found no significant difference in the left ventricular end-systolic volume index (LVESVI) or survival after 1 year. Concomitant Mitral-valve repair was associated with a reduced prevalence of moderate or severe Mitral Regurgitation, but patients had more adverse events. We now report 2-year outcomes. MethodsWe randomly assigned 301 patients to undergo either CABG alone or the combined procedure. Patients were followed for 2 years for clinical and echocardiographic outcomes. ResultsAt 2 years, the mean (±SD) LVESVI was 41.2±20.0 ml per square meter of body-surface area in the CABG-alone group and 43.2±20.6 ml per square meter in the combined-procedure group (mean improvement over baseline, −14.1 ml per square meter and −14.6 ml per square meter, respectively). The rate of death was 10.6% in the CABG-alone group and 10.0% in the combined-...

  • two year outcomes of surgical treatment of severe ischemic Mitral Regurgitation
    The New England Journal of Medicine, 2016
    Co-Authors: Robert E Michler, Michael A. Acker, Judy Hung, Alan J Moskowitz, Michael K Parides, Gorav Ailawadi, Vinod H Thourani, Helena L Chang, Pete Smith, Louis P Perrault
    Abstract:

    BackgroundIn a trial comparing coronary-artery bypass grafting (CABG) alone with CABG plus Mitral-valve repair in patients with moderate ischemic Mitral Regurgitation, we found no significant difference in the left ventricular end-systolic volume index (LVESVI) or survival after 1 year. Concomitant Mitral-valve repair was associated with a reduced prevalence of moderate or severe Mitral Regurgitation, but patients had more adverse events. We now report 2-year outcomes. MethodsWe randomly assigned 301 patients to undergo either CABG alone or the combined procedure. Patients were followed for 2 years for clinical and echocardiographic outcomes. ResultsAt 2 years, the mean (±SD) LVESVI was 41.2±20.0 ml per square meter of body-surface area in the CABG-alone group and 43.2±20.6 ml per square meter in the combined-procedure group (mean improvement over baseline, −14.1 ml per square meter and −14.6 ml per square meter, respectively). The rate of death was 10.6% in the CABG-alone group and 10.0% in the combined-...

  • predicting recurrent Mitral Regurgitation after Mitral valve repair for severe ischemic Mitral Regurgitation
    The Journal of Thoracic and Cardiovascular Surgery, 2015
    Co-Authors: Irving L. Kron, Judy Hung, Jessica Overbey, Denis Bouchard, Annetine C Gelijns, Alan J Moskowitz, Pierre Voisine, Patrick T Ogara, Michael Argenziano, Robert E Michler
    Abstract:

    Abstract Objectives The Cardiothoracic Surgical Trials Network recently reported no difference in the primary end point of left ventricular end-systolic volume index at 1 year postsurgery in patients randomized to repair (n = 126) or replacement (n = 125) for severe ischemic Mitral Regurgitation. However, patients undergoing repair experienced significantly more recurrent Mitral Regurgitation than patients undergoing replacement (32.6% vs 2.3%). We examined whether baseline echocardiographic and clinical characteristics could identify those who will develop moderate/severe recurrent Mitral Regurgitation or die. Methods Our analysis includes 116 patients who were randomized to and received Mitral valve repair. Logistic regression was used to estimate a model-based probability of recurrence or death from baseline factors. Receiver operating characteristic curves were constructed from these estimated probabilities to determine classification cut-points maximizing accuracy of prediction based on sensitivity and specificity. Results Of the 116 patients, 6 received a replacement before leaving the operating room; all other patients had mild or less Mitral Regurgitation on intraoperative echocardiogram after repair. During the 2-year follow-up period, 76 patients developed moderate/severe Mitral Regurgitation or died (53 Mitral Regurgitation recurrences, 13 Mitral Regurgitation recurrences and death, and 10 deaths). The mechanism for recurrent Mitral Regurgitation was largely Mitral valve leaflet tethering. Our model (including age, body mass index, sex, race, effective regurgitant orifice area, basal aneurysm/dyskinesis, New York Heart Association class, history of coronary artery bypass grafting, percutaneous coronary intervention, or ventricular arrhythmias) yielded an area under the receiver operating characteristic curve of 0.82. Conclusions The model demonstrated good discrimination in identifying patients who will survive 2 years without recurrent Mitral Regurgitation after Mitral valve repair. Although our results require validation, they offer a clinically relevant risk score for selection of surgical candidates for this procedure.

  • surgical treatment of moderate ischemic Mitral Regurgitation
    The New England Journal of Medicine, 2014
    Co-Authors: Peter K Smith, Judy Hung, Annetine C Gelijns, Alan J Moskowitz, Pierre Voisine, John D Puskas, Deborah D Ascheim, Michael K Parides, Gorav Ailawadi, Louis P Perrault
    Abstract:

    Background Ischemic Mitral Regurgitation is associated with increased mortality and morbidity. For surgical patients with moderate Regurgitation, the benefits of adding Mitralvalve repair to coronary-artery bypass grafting (CABG) are uncertain. Methods We randomly assigned 301 patients with moderate ischemic Mitral Regurgitation to CABG alone or CABG plus Mitral-valve repair (combined procedure). The primary end point was the left ventricular end-systolic volume index (LVESVI), a measure of left ventricular remodeling, at 1 year. This end point was assessed with the use of a Wilcoxon rank-sum test in which deaths were categorized as the lowest LVESVI rank. Results At 1 year, the mean LVESVI among surviving patients was 46.1±22.4 ml per square meter of body-surface area in the CABG-alone group and 49.6±31.5 ml per square meter in the combined-procedure group (mean change from baseline, −9.4 and −9.3 ml per square meter, respectively). The rate of death was 6.7% in the combined-procedure group and 7.3% in the CABG-alone group (hazard ratio with Mitral-valve repair, 0.90; 95% confidence interval, 0.38 to 2.12; P = 0.81). The rank-based assessment of LVESVI at 1 year (incorporating deaths) showed no significant between-group difference (z score, 0.50; P = 0.61). The addition of Mitral-valve repair was associated with a longer bypass time (P<0.001), a longer hospital stay after surgery (P = 0.002), and more neurologic events (P = 0.03). Moderate or severe Mitral Regurgitation was less common in the combined-procedure group than in the CABG-alone group (11.2% vs. 31.0%, P<0.001). There were no significant between-group differences in major adverse cardiac or cerebrovascular events, deaths, readmissions, functional status, or quality of life at 1 year. Conclusions In patients with moderate ischemic Mitral Regurgitation, the addition of Mitral-valve repair to CABG did not result in a higher degree of left ventricular reverse remodeling. Mitral-valve repair was associated with a reduced prevalence of moderate or severe Mitral Regurgitation but an increased number of untoward events. Thus, at 1 year, this trial did not show a clinically meaningful advantage of adding Mitral-valve repair to CABG. Longer-term follow-up may determine whether the lower prevalence of Mitral Regurgitation translates into a net clinical benefit. (Funded by the National Institutes of Health and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00806988.)

Judy Hung - One of the best experts on this subject based on the ideXlab platform.

  • transcatheter Mitral valve repair for functional Mitral Regurgitation evaluating the evidence
    The Journal of Thoracic and Cardiovascular Surgery, 2020
    Co-Authors: Annetine C Gelijns, Judy Hung, Alan J Moskowitz, Patrick T Ogara, Gorav Ailawadi, Gennaro Giustino, Michael J Mack, Donna Mancini, Emilia Bagiella, Martin B Leon
    Abstract:

    Abstract Objectives Two trials (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation Trial and Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation Trial) were published in 2018 evaluating the effectiveness and safety of transcatheter repair for patients with heart failure with significant functional Mitral Regurgitation, which yielded different results. This article reviews the strength of the evidence, differences in trial designs, ethical and implementation implications, and delineates future research needs to help guide the appropriate dissemination of transcatheter repair for functional patients with Mitral Regurgitation. Methods The National Heart, Lung, and Blood Institute convened a workshop of interdisciplinary experts to address these objectives. Results Transcatheter repair of functional Mitral Regurgitation can provide significant benefits in terms of heart failure hospitalizations, survival, and quality of life when appropriate heart failure candidates with moderate to severe or severe Mitral Regurgitation while on optimal guideline-directed medical therapy can be identified. Key ingredients for success are preoperative evaluation and management and postoperative care by an interdisciplinary heart team. Conclusions Given the discordance observed between trials, ongoing innovation in patient management, and potential expansion of indications for use, the evidence base must be expanded to optimize appropriate implementation of this complex therapy. This will require more complete capture of outcome data in real-world settings for all eligible candidates whether or not they receive this therapy. Inevitably, the indications for use of this therapy will expand, as will the devices and therapeutic approaches for this population, necessitating the study of comparative effectiveness through randomized trials or observational studies. Moreover, given the substantial variations in care delivery, conducting implementation research to delineate characteristics of the optimal care model would be of benefit.

  • two year outcomes of surgical treatment of moderate ischemic Mitral Regurgitation
    The New England Journal of Medicine, 2016
    Co-Authors: Robert E Michler, Michael A. Acker, Judy Hung, Alan J Moskowitz, Peter K Smith, Michael K Parides, Gorav Ailawadi, Vinod H Thourani, Helena L Chang, Louis P Perrault
    Abstract:

    BackgroundIn a trial comparing coronary-artery bypass grafting (CABG) alone with CABG plus Mitral-valve repair in patients with moderate ischemic Mitral Regurgitation, we found no significant difference in the left ventricular end-systolic volume index (LVESVI) or survival after 1 year. Concomitant Mitral-valve repair was associated with a reduced prevalence of moderate or severe Mitral Regurgitation, but patients had more adverse events. We now report 2-year outcomes. MethodsWe randomly assigned 301 patients to undergo either CABG alone or the combined procedure. Patients were followed for 2 years for clinical and echocardiographic outcomes. ResultsAt 2 years, the mean (±SD) LVESVI was 41.2±20.0 ml per square meter of body-surface area in the CABG-alone group and 43.2±20.6 ml per square meter in the combined-procedure group (mean improvement over baseline, −14.1 ml per square meter and −14.6 ml per square meter, respectively). The rate of death was 10.6% in the CABG-alone group and 10.0% in the combined-...

  • two year outcomes of surgical treatment of severe ischemic Mitral Regurgitation
    The New England Journal of Medicine, 2016
    Co-Authors: Robert E Michler, Michael A. Acker, Judy Hung, Alan J Moskowitz, Michael K Parides, Gorav Ailawadi, Vinod H Thourani, Helena L Chang, Pete Smith, Louis P Perrault
    Abstract:

    BackgroundIn a trial comparing coronary-artery bypass grafting (CABG) alone with CABG plus Mitral-valve repair in patients with moderate ischemic Mitral Regurgitation, we found no significant difference in the left ventricular end-systolic volume index (LVESVI) or survival after 1 year. Concomitant Mitral-valve repair was associated with a reduced prevalence of moderate or severe Mitral Regurgitation, but patients had more adverse events. We now report 2-year outcomes. MethodsWe randomly assigned 301 patients to undergo either CABG alone or the combined procedure. Patients were followed for 2 years for clinical and echocardiographic outcomes. ResultsAt 2 years, the mean (±SD) LVESVI was 41.2±20.0 ml per square meter of body-surface area in the CABG-alone group and 43.2±20.6 ml per square meter in the combined-procedure group (mean improvement over baseline, −14.1 ml per square meter and −14.6 ml per square meter, respectively). The rate of death was 10.6% in the CABG-alone group and 10.0% in the combined-...

  • predicting recurrent Mitral Regurgitation after Mitral valve repair for severe ischemic Mitral Regurgitation
    The Journal of Thoracic and Cardiovascular Surgery, 2015
    Co-Authors: Irving L. Kron, Judy Hung, Jessica Overbey, Denis Bouchard, Annetine C Gelijns, Alan J Moskowitz, Pierre Voisine, Patrick T Ogara, Michael Argenziano, Robert E Michler
    Abstract:

    Abstract Objectives The Cardiothoracic Surgical Trials Network recently reported no difference in the primary end point of left ventricular end-systolic volume index at 1 year postsurgery in patients randomized to repair (n = 126) or replacement (n = 125) for severe ischemic Mitral Regurgitation. However, patients undergoing repair experienced significantly more recurrent Mitral Regurgitation than patients undergoing replacement (32.6% vs 2.3%). We examined whether baseline echocardiographic and clinical characteristics could identify those who will develop moderate/severe recurrent Mitral Regurgitation or die. Methods Our analysis includes 116 patients who were randomized to and received Mitral valve repair. Logistic regression was used to estimate a model-based probability of recurrence or death from baseline factors. Receiver operating characteristic curves were constructed from these estimated probabilities to determine classification cut-points maximizing accuracy of prediction based on sensitivity and specificity. Results Of the 116 patients, 6 received a replacement before leaving the operating room; all other patients had mild or less Mitral Regurgitation on intraoperative echocardiogram after repair. During the 2-year follow-up period, 76 patients developed moderate/severe Mitral Regurgitation or died (53 Mitral Regurgitation recurrences, 13 Mitral Regurgitation recurrences and death, and 10 deaths). The mechanism for recurrent Mitral Regurgitation was largely Mitral valve leaflet tethering. Our model (including age, body mass index, sex, race, effective regurgitant orifice area, basal aneurysm/dyskinesis, New York Heart Association class, history of coronary artery bypass grafting, percutaneous coronary intervention, or ventricular arrhythmias) yielded an area under the receiver operating characteristic curve of 0.82. Conclusions The model demonstrated good discrimination in identifying patients who will survive 2 years without recurrent Mitral Regurgitation after Mitral valve repair. Although our results require validation, they offer a clinically relevant risk score for selection of surgical candidates for this procedure.

  • surgical treatment of moderate ischemic Mitral Regurgitation
    The New England Journal of Medicine, 2014
    Co-Authors: Peter K Smith, Judy Hung, Annetine C Gelijns, Alan J Moskowitz, Pierre Voisine, John D Puskas, Deborah D Ascheim, Michael K Parides, Gorav Ailawadi, Louis P Perrault
    Abstract:

    Background Ischemic Mitral Regurgitation is associated with increased mortality and morbidity. For surgical patients with moderate Regurgitation, the benefits of adding Mitralvalve repair to coronary-artery bypass grafting (CABG) are uncertain. Methods We randomly assigned 301 patients with moderate ischemic Mitral Regurgitation to CABG alone or CABG plus Mitral-valve repair (combined procedure). The primary end point was the left ventricular end-systolic volume index (LVESVI), a measure of left ventricular remodeling, at 1 year. This end point was assessed with the use of a Wilcoxon rank-sum test in which deaths were categorized as the lowest LVESVI rank. Results At 1 year, the mean LVESVI among surviving patients was 46.1±22.4 ml per square meter of body-surface area in the CABG-alone group and 49.6±31.5 ml per square meter in the combined-procedure group (mean change from baseline, −9.4 and −9.3 ml per square meter, respectively). The rate of death was 6.7% in the combined-procedure group and 7.3% in the CABG-alone group (hazard ratio with Mitral-valve repair, 0.90; 95% confidence interval, 0.38 to 2.12; P = 0.81). The rank-based assessment of LVESVI at 1 year (incorporating deaths) showed no significant between-group difference (z score, 0.50; P = 0.61). The addition of Mitral-valve repair was associated with a longer bypass time (P<0.001), a longer hospital stay after surgery (P = 0.002), and more neurologic events (P = 0.03). Moderate or severe Mitral Regurgitation was less common in the combined-procedure group than in the CABG-alone group (11.2% vs. 31.0%, P<0.001). There were no significant between-group differences in major adverse cardiac or cerebrovascular events, deaths, readmissions, functional status, or quality of life at 1 year. Conclusions In patients with moderate ischemic Mitral Regurgitation, the addition of Mitral-valve repair to CABG did not result in a higher degree of left ventricular reverse remodeling. Mitral-valve repair was associated with a reduced prevalence of moderate or severe Mitral Regurgitation but an increased number of untoward events. Thus, at 1 year, this trial did not show a clinically meaningful advantage of adding Mitral-valve repair to CABG. Longer-term follow-up may determine whether the lower prevalence of Mitral Regurgitation translates into a net clinical benefit. (Funded by the National Institutes of Health and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00806988.)