{"id":"6bf36743b68d","type":"article","url":"https://hartvaat.nl/2016/01/28/mitralisklepchirurgie-bij-ernstige-ischemische-mitralisklepinsufficientie-2-jaar/","title":"Mitralisklepchirurgie bij ernstige ischemische mitralisklepinsufficiëntie: 2-jaarsresultaten","title_en":"Two-Year Outcomes of Surgical Treatment of Severe Ischemic Mitral Regurgitation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["mitralisinsufficiëntie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1512913","source_url":"https://doi.org/10.1056/NEJMoa1512913","authors":["Daniel Goldstein","Alan J Moskowitz","Annetine C Gelijns","Gorav Ailawadi","Michael K Parides","Louis P Perrault","Judy W Hung","Pierre Voisine","Francois Dagenais","A Marc Gillinov","Vinod Thourani","Michael Argenziano","James S Gammie","Michael Mack","Philippe Demers","Pavan Atluri","Eric A Rose","Karen O'Sullivan","Deborah L Williams","Emilia Bagiella","Robert E Michler","Richard D Weisel","Marissa A Miller","Nancy L Geller","Wendy C Taddei-Peters","Peter K Smith","Ellen Moquete","Jessica R Overbey","Irving L Kron","Patrick T O'Gara","Michael A Acker"],"significance":8,"published":"2016-01-28","source_date":"2016-01-28","image":"","kennis":[],"congress":"","summary_en":"This NEJM trial found that at 2 years, mitral valve replacement was associated with better outcomes than repair in patients with severe ischemic mitral regurgitation, driven by a high rate of recurrent MR after repair. The results challenged the repair-first dogma in functional mitral regurgitation.","created":"2026-07-03T10:25:54Z","updated":"2026-07-03T13:25:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial die mitralisklepherstel vergeleek met klepvervanging bij patiënten met ernstige ischemische mitralisklepinsufficiëntie. Na twee jaar was er geen significant verschil in linkerkamervolume, overleving of complicaties tussen beide strategieën.","abstract_original":"BACKGROUND: In a randomized trial comparing mitral-valve repair with mitral-valve replacement in patients with severe ischemic mitral regurgitation, we found no significant difference in the left ventricular end-systolic volume index (LVESVI), survival, or adverse events at 1 year after surgery. However, patients in the repair group had significantly more recurrences of moderate or severe mitral regurgitation. We now report the 2-year outcomes of this trial. METHODS: We randomly assigned 251 patients to mitral-valve repair or replacement. Patients were followed for 2 years, and clinical and echocardiographic outcomes were assessed. RESULTS: Among surviving patients, the mean (±SD) 2-year LVESVI was 52.6±27.7 ml per square meter of body-surface area with mitral-valve repair and 60.6±39.0 ml per square meter with mitral-valve replacement (mean changes from baseline, -9.0 ml per square meter and -6.5 ml per square meter, respectively). Two-year mortality was 19.0% in the repair group and 23.2% in the replacement group (hazard ratio in the repair group, 0.79; 95% confidence interval, 0.46 to 1.35; P=0.39). The rank-based assessment of LVESVI at 2 years (incorporating deaths) showed no significant between-group difference (z score=-1.32, P=0.19). The rate of recurrence of moderate or severe mitral regurgitation over 2 years was higher in the repair group than in the replacement group (58.8% vs. 3.8%, P<0.001). There were no significant between-group differences in rates of serious adverse events and overall readmissions, but patients in the repair group had more serious adverse events related to heart failure (P=0.05) and cardiovascular readmissions (P=0.01). On the Minnesota Living with Heart Failure questionnaire, there was a trend toward greater improvement in the replacement group (P=0.07). CONCLUSIONS: In patients undergoing mitral-valve repair or replacement for severe ischemic mitral regurgitation, we observed no significant between-group difference in left ventricular reverse remodeling or survival at 2 years. Mitral regurgitation recurred more frequently in the repair group, resulting in more heart-failure-related adverse events and cardiovascular admissions. (Funded by the National Institutes of Health and Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00807040.)."}