PubMed:24245543 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PubMed/sourceid/24245543","sourcedb":"PubMed","sourceid":"24245543","source_url":"http://www.ncbi.nlm.nih.gov/pubmed/24245543","text":"Mitral-valve repair versus replacement for severe ischemic mitral regurgitation.\nBACKGROUND: Ischemic mitral regurgitation is associated with a substantial risk of death. Practice guidelines recommend surgery for patients with a severe form of this condition but acknowledge that the supporting evidence for repair or replacement is limited.\nMETHODS: We randomly assigned 251 patients with severe ischemic mitral regurgitation to undergo either mitral-valve repair or chordal-sparing replacement in order to evaluate efficacy and safety. The primary end point was the left ventricular end-systolic volume index (LVESVI) at 12 months, as assessed with the use of a Wilcoxon rank-sum test in which deaths were categorized below the lowest LVESVI rank.\nRESULTS: At 12 months, the mean LVESVI among surviving patients was 54.6±25.0 ml per square meter of body-surface area in the repair group and 60.7±31.5 ml per square meter in the replacement group (mean change from baseline, -6.6 and -6.8 ml per square meter, respectively). The rate of death was 14.3% in the repair group and 17.6% in the replacement group (hazard ratio with repair, 0.79; 95% confidence interval, 0.42 to 1.47; P=0.45 by the log-rank test). There was no significant between-group difference in LVESVI after adjustment for death (z score, 1.33; P=0.18). The rate of moderate or severe recurrence of mitral regurgitation at 12 months was higher in the repair group than in the replacement group (32.6% vs. 2.3%, P\u003c0.001). There were no significant between-group differences in the rate of a composite of major adverse cardiac or cerebrovascular events, in functional status, or in quality of life at 12 months.\nCONCLUSIONS: We observed no significant difference in left ventricular reverse remodeling or survival at 12 months between patients who underwent mitral-valve repair and those who underwent mitral-valve replacement. Replacement provided a more durable correction of mitral regurgitation, but there was no significant between-group difference in clinical outcomes. (Funded by the National Institutes of Health and the Canadian Institutes of Health; ClinicalTrials.gov number, NCT00807040.).","tracks":[{"project":"Allie","denotations":[{"id":"SS1_24245543_6_0","span":{"begin":568,"end":610},"obj":"expanded"},{"id":"SS2_24245543_6_0","span":{"begin":612,"end":618},"obj":"abbr"}],"relations":[{"id":"AE1_24245543_6_0","pred":"abbreviatedTo","subj":"SS1_24245543_6_0","obj":"SS2_24245543_6_0"}],"attributes":[{"subj":"SS1_24245543_6_0","pred":"source","obj":"Allie"},{"subj":"SS2_24245543_6_0","pred":"source","obj":"Allie"}]},{"project":"PubmedHPO","denotations":[{"id":"T1","span":{"begin":102,"end":122},"obj":"HP_0001653"}],"attributes":[{"subj":"T1","pred":"source","obj":"PubmedHPO"}]},{"project":"maxiaofeng52_800_3","denotations":[{"id":"T1","span":{"begin":59,"end":79},"obj":"DP"},{"id":"T2","span":{"begin":406,"end":426},"obj":"DP"},{"id":"T3","span":{"begin":102,"end":122},"obj":"DP"},{"id":"T4","span":{"begin":1368,"end":1388},"obj":"DP"},{"id":"T5","span":{"begin":1945,"end":1965},"obj":"DP"}],"attributes":[{"subj":"T1","pred":"source","obj":"maxiaofeng52_800_3"},{"subj":"T2","pred":"source","obj":"maxiaofeng52_800_3"},{"subj":"T3","pred":"source","obj":"maxiaofeng52_800_3"},{"subj":"T4","pred":"source","obj":"maxiaofeng52_800_3"},{"subj":"T5","pred":"source","obj":"maxiaofeng52_800_3"}]},{"project":"wangzhuo19_800_3","denotations":[{"id":"T4","span":{"begin":1368,"end":1388},"obj":"DP"},{"id":"T5","span":{"begin":59,"end":79},"obj":"DP"},{"id":"T6","span":{"begin":102,"end":122},"obj":"DP"},{"id":"T7","span":{"begin":406,"end":426},"obj":"DP"},{"id":"T8","span":{"begin":1945,"end":1965},"obj":"DP"}],"attributes":[{"subj":"T4","pred":"source","obj":"wangzhuo19_800_3"},{"subj":"T5","pred":"source","obj":"wangzhuo19_800_3"},{"subj":"T6","pred":"source","obj":"wangzhuo19_800_3"},{"subj":"T7","pred":"source","obj":"wangzhuo19_800_3"},{"subj":"T8","pred":"source","obj":"wangzhuo19_800_3"}]}],"config":{"attribute types":[{"pred":"source","value type":"selection","values":[{"id":"Allie","color":"#ec93d5","default":true},{"id":"PubmedHPO","color":"#93ece8"},{"id":"maxiaofeng52_800_3","color":"#ecce93"},{"id":"wangzhuo19_800_3","color":"#b493ec"}]}]}}