Presentation Abstract

Session: LBCT.03-Medical and Surgical Approaches to Improving Heart Failure Outcomes
Presentation: Severe Ischemic Mitral Regurgitation: Is it Better to Repair or Replace the Valve?
Pres Time: Monday, Nov 18, 2013, 11:29 AM -11:39 AM
Location: Hall E
Pres. Time: Monday, Nov 18, 2013, 11:29 AM -11:39 AM
Specialty: Surgery
Presenter: Michael A Acker, Hosp of the Univ of Pennsylvania, Philadelphia, PA
Abstract: BACKGROUND Ischemic mitral regurgitation (MR), which develops as a complication of myocardial infarction and adverse left ventricular remodeling, is associated with significant mortality risk over time. Practice guidelines recommend repair or replacement for severe, ischemic MR, but there remains a lack of conclusive evidence to indicate which of these interventions is superior. The choice between these surgical options is characterized by the trade-off between reduced operative morbidity and mortality with repair versus better long-term correction of ischemic MR with replacement. The long-term benefits of repair versus replacement remain unknown, which has led to uncertainty and significant variation in surgical practice.
METHODS The severe MR (SMR) randomized trial was designed to evaluate the safety and effectiveness of mitral valve repair versus replacement in patients with severe ischemic MR. This trial is being conducted as part of the NIH and CIHR supported Cardiothoracic Surgical Trials Network (CTSN) in 22 clinical centers. The primary endpoint for the trial is the degree of left ventricular remodeling, as assessed by Left Ventricular End Systolic Volume Index (LVESVI) at 12 mos post-surgery by TTE (integrative method). Secondary endpoints include mortality, MACE, adverse events, recurrent MR, QoL, and hospitalizations (24 mos).
RESULTS The patient population consists of 251 patients with severe ischemic MR (often with tethering as a major mechanism) with and without need for CABG (table). The mean baseline LVESVI was 63.4 (±26.8). The average follow-up time of the cohort is 19 months as of 6/18/13 and all patients have recently completed their one-year endpoint assessment. Primary and secondary endpoint data will be presented.
CONCLUSIONS The approach to managing ischemic MR remains controversial. The results of the trial will help delineate the appropriate therapeutic approach for this growing patient population.

Disclosures:   M.A. Acker: Consultant/Advisory Board; Modest; Thoratec Inc.. M.K. Parides: None. L.P. Perrault: None. A.J. Moskowitz: None. P. Voisine: None. P.K. Smith: None. A.C. Gelijns: None. J.W. Hung: None. E. Blackstone: None. J. Puskas: None. M. Argenziano: None. J.S. Gammie: None. M. Mack: None. D.D. Ascheim: Consultant/Advisory Board; Modest; Backbeat Medical, Inc., Velomedix. E. Bagiella: None. T. Ferguson: None. K. Horvath: None. N.L. Geller: None. M.A. Miller: None. J.Y. Woo: None. D.A. D'Alessandro: None. G. Ailawadi: Research Grant; Significant; Astra Zeneca ( investigation of aneurysms). Speakers Bureau; Modest; St. Jude speaker, Atricure proctor. Consultant/Advisory Board; Modest; Abbott, Edwards. F. Dagenais: None. T.J. Gardner: Other; Modest; Chair, Steering Committee, Cardiothoracic Surgical Trials Network, NHLBI. P.T. O'Gara: None. R. Michler: None. I.L. Kron: None.

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