Percutaneous repair or surgery for mitral regurgitation

January 01, 0001

Percutaneous repair or surgery for mitral regurgitation

Mitral-valve repair can be accomplished with an investigational procedure that involves the percutaneous implantation of a clip that grasps and approximates the edges of the mitral leaflets at the origin of the regurgitant jet. These US authors randomly assigned 279 patients with moderately severe or severe (grade 3+ or 4+) mitral regurgitation in a 2:1 ratio to undergo either percutaneous repair or conventional surgery for repair or replacement of the mitral valve. The primary composite end point for efficacy was freedom from death, from surgery for mitral-valve dysfunction, and from grade 3+ or 4+ mitral regurgitation at 12 months. The primary safety end point was a composite of major adverse events within 30 days.

They found: "At 12 months, the rates of the primary end point for efficacy were 55% in the percutaneous-repair group and 73% in the surgery group. The respective rates of the components of the primary end point were as follows: death, 6% in each group; surgery for mitral-valve dysfunction, 20% versus 2%; and grade 3+ or 4+ mitral regurgitation, 21% versus 20%. Major adverse events occurred in 15% of patients in the percutaneous-repair group and 48% of patients in the surgery group at 30 days. At 12 months, both groups had improved left ventricular size, New York Heart Association functional class, and quality-of-life measures, as compared with baseline."

The authors concluded: "Although percutaneous repair was less effective at reducing mitral regurgitation than conventional surgery, the procedure was associated with superior safety and similar improvements in clinical outcomes."

Percutaneous repair for mitral valve regurgitation appears to be a promising option.

For the full abstract, click here.

N Engl J Med 364:1395-1406, 14 April 2011
© 2011 to the American Medical Association
Percutaneous Repair or Surgery for Mitral Regurgitation. Ted Feldman, Elyse Foster, Donald G. Glower, et al. Correspondence to Dr. Feldman: [email protected]

Category: K. Circulatory. Keywords: mitral valve regurgitation, percutaneous repair, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 29 April 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.