Optimal surgical management of severe ischemic mitral regurgitation: To repair or to replace?
Optimal surgical management of severe ischemic mitral regurgitation: To repair or to replace?
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DOI：
10.1016/j.jtcvs.2011.05.030
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发表时间：
2012-06-01
影响因子：
6
通讯作者：
Parides, Michael K.
中科院分区：
文献类型：
--
作者：
Perrault, Louis P.;Moskowitz, Alan J.;Parides, Michael K.
背景资料：缺血性二尖瓣返流是心肌梗死和冠状动脉疾病的并发症，与高死亡率相关，估计影响280万美国人。由于1年死亡率高达40%，专业协会最近的实践指南建议进行修复或更换，但仍然缺乏支持这两种干预措施的确凿证据。治疗选择的特点是在修复术降低手术发病率和死亡率与置换术更好地长期纠正二尖瓣关闭不全之间进行权衡。修复与置换的长期利益仍然未知，这导致了显着的变化，在手术practice.Methods和结果：本文介绍了一个前瞻性随机临床试验的设计，以评估二尖瓣修复和置换术的安全性和有效性，严重缺血性二尖瓣返流患者。本试验作为心胸外科试验网络的一部分进行。本文讨论了在选择一个可行的主要终点的挑战，特点的目标人群（包括二尖瓣返流的程度）和分析的挑战，在这个高死亡率diseases.Conclusions：文章的结论是讨论的重要性信息的功能状态，生存，神经认知，生活质量，和心脏生理学在治疗决策。（《胸血管外科杂志》2012;143：1396-403）
Background: Ischemic mitral regurgitation, a complication of myocardial infarction and coronary artery disease more generally, is associated with a high mortality rate and is estimated to affect 2.8 million Americans. With 1-year mortality rates as high as 40%, recent practice guidelines of professional societies recommend repair or replacement, but there remains a lack of conclusive evidence supporting either intervention. The choice between therapeutic options is characterized by the trade-off between reduced operative morbidity and mortality with repair versus a better long-term correction of mitral insufficiency with replacement. The long-term benefits of repair versus replacement remain unknown, which has led to significant variation in surgical practice.Methods and Results: This article describes the design of a prospective randomized clinical trial to evaluate the safety and effectiveness of mitral valve repair and replacement in patients with severe ischemic mitral regurgitation. This trial is being conducted as part of the Cardiothoracic Surgical Trials Network. This article addresses challenges in selecting a feasible primary end point, characterizing the target population (including the degree of mitral regurgitation) and analytical challenges in this high mortality disease.Conclusions: The article concludes by discussing the importance of information on functional status, survival, neurocognition, quality of life, and cardiac physiology in therapeutic decision making. (J Thorac Cardiovasc Surg 2012;143:1396-403)