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J Thorac Cardiovasc Surg 2006;131:523-529
© 2006 The American Association for Thoracic Surgery

Editorial

Pitfalls and limitations in measuring and interpreting the outcomes of mitral valve repair

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

Received for publication November 17, 2005; accepted for publication November 28, 2005.

^_* Address for reprints: David H. Adams, MD, Professor and Chairman, Department of Cardiothoracic Surgery, 1190 Fifth Avenue, New York, NY 10029 (Email: david.adams@mountsinai.org).

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

In this edition of the journal, Serri and colleagues ¹ present their midterm results of valve repair for ischemic mitral regurgitation. They observed significant mitral regurgitation in over half of their patients during the follow-up period, which averaged 28 months, and implied the need for alternative repair techniques or more mitral valve replacement. This is in line with other recent studies that have also shown a high rate of recurrence of mitral regurgitation after annuloplasty for ischemic mitral regurgitation. ^2-5 Can this justification be reliably drawn? Are current approaches to repair ineffective in a significant number of patients with ischemic mitral regurgitation? Can their results be extrapolated to other centers undertaking repair of ischemic mitral regurgitation? We would argue that the study of Serri and colleagues ¹ displays several common clinical and methodologic pitfalls that limit generalization of results from most studies of mitral valve repair. Below, we outline specific challenges in measuring and reporting outcomes of mitral valve repair. Although we illustrate these using the study of Serri and colleagues, ¹ the pitfalls are not unique to their study and apply to varying degrees in all studies of mitral valve repair. Knowledge of these pitfalls is necessary to improve the quality of outcomes-based research on mitral valve repair, to allow accurate interpretation of these studies, and also to permit useful extrapolation of results.

Defining a Patient Cohort

Serri and colleagues ¹ defined ischemic mitral regurgitation as "mitral regurgitation resulting from prior myocardial infarction associated with normal mitral valve leaflets and chordae." This is an etiologic definition that fails to take into account the valve dysfunction or the lesions that actually result in the mitral regurgitation. What is a "normal mitral leaflet"? Carpentier's pathophysiologic triad describes the interrelationship between leaflet motion (dysfunction), lesions, and etiology. ⁶ Carpentier's classification of dysfunction is based on the opening and closing motions of the . . . [Full Text of this Article]

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