# Mitralisklepchirurgie bij ernstige ischemische mitralisklepinsufficiëntie: 2-jaarsresultaten

*geplaatst 2016-01-28 · Hartfalen · The New England journal of medicine · doi 10.1056/NEJMoa1512913 · https://hartvaat.nl/2016/01/28/mitralisklepchirurgie-bij-ernstige-ischemische-mitralisklepinsufficientie-2-jaar/*

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.

## English: Two-Year Outcomes of Surgical Treatment of Severe Ischemic Mitral Regurgitation.

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.

## Abstract (original, from the publication)

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.).

Auteurs: 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

---
Bron: The New England journal of medicine, https://doi.org/10.1056/NEJMoa1512913. Bijgewerkt 2026-07-03T13:25:16Z. 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.