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J Thorac Cardiovasc Surg 2003;125:1197-1199
© 2003 The American Association for Thoracic Surgery

Editorials

Another chapter in an enlarging book: Repair degenerative mitral valves

From the Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY.

Received for publication Jan 20, 2002. Accepted for publication Feb 11, 2002. Address for reprints: David H. Adams, MD, Department of Cardiothoracic Surgery, Mount Sinai Medical Center, 1190 Fifth Ave, New York, NY 10029, USA (E-mail: david.adams@mountsinai.org).

The first 300 words of the full text of this article appear below.

See related article on page 1350.

In this issue of the Journal, Gillinov and colleagues ¹ provide us with another valuable contribution in the field of mitral valve repair from their large experience at The Cleveland Clinic Foundation available for sophisticated and cutting-edge (ie, Eugene Blackstone) statistical analysis. The superiority of mitral valve repair over replacement in patients with degenerative mitral valve disease is now widely held to be true. It would be surprising to see a single hand raised in a medical audience today if you asked, "Who would prefer to have his or her own valve replaced instead of repaired?" Intuitively it is attractive to keep the parts you were born with. Other potential advantages including better preservation of left ventricular function, avoidance of long-term anticoagulation (mechanical valves) or reoperation (bioprosthetic valves), and improved survival all favor mitral valve repair as the gold standard. ^2-5 Should the need for a concomitant coronary artery bypass procedure change the paradigm? This is the important question addressed by Gillinov and associates in their analysis of 679 patients with degenerative mitral valve disease and ischemic heart disease undergoing coronary bypass grafting and mitral valve surgery (repair or replacement). It is not surprising that their data provide further confirmation of the superiority of mitral valve repair over replacement in terms of survival, the only end point examined. Impressively, the benefit of mitral valve repair in patients with degenerative mitral regurgitation was noted as early as 2 years after the surgical procedure. This important observation reinforces that the necessity for coronary bypass grafting should not influence our determination to repair rather than replace a degenerative mitral valve.

The authors were challenged by the retrospective nature of their analysis, which included patients undergoing surgery over a 3-decade span: (1) Valve replacements were more prevalent in the . . . [Full Text of this Article]

Related Article

Repair versus replacement for degenerative mitral valve disease with coexisting ischemic heart disease

A. Marc Gillinov, Christiano Faber, Penny L. Houghtaling, Eugene H. Blackstone, Buu-Khanh Lam, Ramon Diaz, Bruce W. Lytle, Joseph F. Sabik, III, and Delos M. Cosgrove, III
J. Thorac. Cardiovasc. Surg. 2003 125: 1350-1362. [Abstract] [Full Text] [PDF]

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