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J Thorac Cardiovasc Surg. 2015 Mar;149(3):752-61.e1. doi: 10.1016/j.jtcvs.2014.10.120. Epub 2014 Nov 6.

Predicting recurrent mitral regurgitation after mitral valve repair for severe ischemic mitral regurgitation.

Collaborators (207)

Miller MA, Taddei-Peters WC, Buxton D, Caulder R, Geller NL, Gordon D, Jeffries NO, Lee A, Moy CS, Kogan Gombos I, Ralph J, Weisel R, Gardner TJ, O'Gara PT, Rose EA, Gelijns AC, Parides MK, Ascheim DD, Moskowitz AJ, Moquete E, Chang H, Chase M, Chen Y, Gupta L, Kirkwood K, Kumbarce E, Levitan R, O'Sullivan K, Overbey J, Santos M, Weglinski M, Weinberg A, Williams P, Wood C, Ye X, Mack M, Adame T, Settele N, Adams J, Ryan W, Smith RL, Grayburn P, Chen FY, Nohria A, Cohn L, Shekar P, Aranki S, Couper G, Davidson M, Bolman R 3rd, Burgess A, Conboy D, Blackstone EH, Gillinov A, Lackner P, Berroteran L, Dolney D, Fleming S, Palumbo R, Whitman C, Sankovic K, Kosty Sweeney D, Pattakos G, Clarke PA, Argenziano M, Williams M, Goldsmith L, Smith CR, Naka Y, Stewart A, Schwartz A, Bell D, Van Patten D, Smith PK, Alexander JH, Milano CA, Glower DD, Mathew JP, Harrison J, Welsh S, Berry MF, Parsa CJ, Tong BC, Williams JB, Ferguson T, Kypson AP, Rodriguez E, Harris M, Akers B, O'Neal A, Puskas JD, Thourani VH, Guyton R, Baer J, Baio K, Neill AA, Voisine P, Senechal M, Dagenais F, O'Connor K, Dussault G, Ballivian T, Keilani S, Speir AM, Magee P, Ad N, Keyte S, Dang M, Slaughter M, Headlee M, Moody H, Solankhi N, Birks E, Groh MA, Shell LE, Shepard SA, Trichon BH, Nanney T, Hampton LC, Michler RE, D'Alessandro DA, DeRose JJ Jr, Goldstein DJ, Bello R, Jakobleff W, Garcia M, Taub C, Spevak D, Swayze R, Perrault LP, Basmadjian AJ, Bouchard D, Carrier M, Cartier R, Pellerin M, Tanguay JF, El-Hamamsy I, Denault A, Lacharité J, Robichaud S, Horvath KA, Corcoran PC, Siegenthaler MP, Murphy M, Iraola M, Greenberg A, Sai-Sudhakar C, Hasan A, McDavid A, Kinn B, Pagé P, Sirois C, Gammie JS, Young CA, Beach D, Acker MA, Woo Y, Mayer ML, Bowdish M, Starnes VA, Shavalle D, Matthews R, Javadifar S, Romar L, Kron IL, Ailawadi G, Johnston K, Dent JM, Kern J, Keim J, Burks S, Gahring K, Bull DA, Desvigne-Nickens P, Dixon DO, Haigney M, Holubkov R, Jacobs A, Miller F, Murkin JM, Spertus J, Wechsler AS, Sellke F, McDonald CL, Byington R, Dickert N, Dixon DO, Ikonomidis JS, Williams DO, Yancy CW, Fang JC, Giannetti N, Richenbacher W, Rao V, Furie KL, Miller R, Pinney S, Roberts WC, Walsh MN, Keteyian SJ, Brawner CA, Aldred H, Hung J, Zeng X, Mathew JP, Browndyke J, Toulgoat-Dubois Y.

Author information

Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Va.
Division of Cardiology, Massachusetts General Hospital, Boston, Mass.
International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada.
International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address:
Institut Universitaire de Cardiologie de Quebec, Hopital Laval, Quebec, Canada.
Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass.
Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY.
Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY.
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
Department of Cardiac Surgery, Mount Sinai Beth Israel, Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Division of Cardiac Surgery, University of Maryland, Baltimore, Md.
Cardiothoracic Surgery, Baylor Research Institute, Baylor Scott & White Health, Plano, Tex.
Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, NC.
Cardiac Surgery, The Ohio State University Medical Center, Columbus, Ohio.
Center for Heart & Vascular Health, Christiana Care Health System, Newark, Del.
Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.



The Cardiothoracic Surgical Trials Network recently reported no difference in the primary end point of left ventricular end-systolic volume index at 1 year postsurgery in patients randomized to repair (n = 126) or replacement (n = 125) for severe ischemic mitral regurgitation. However, patients undergoing repair experienced significantly more recurrent mitral regurgitation than patients undergoing replacement (32.6% vs 2.3%). We examined whether baseline echocardiographic and clinical characteristics could identify those who will develop moderate/severe recurrent mitral regurgitation or die.


Our analysis includes 116 patients who were randomized to and received mitral valve repair. Logistic regression was used to estimate a model-based probability of recurrence or death from baseline factors. Receiver operating characteristic curves were constructed from these estimated probabilities to determine classification cut-points maximizing accuracy of prediction based on sensitivity and specificity.


Of the 116 patients, 6 received a replacement before leaving the operating room; all other patients had mild or less mitral regurgitation on intraoperative echocardiogram after repair. During the 2-year follow-up period, 76 patients developed moderate/severe mitral regurgitation or died (53 mitral regurgitation recurrences, 13 mitral regurgitation recurrences and death, and 10 deaths). The mechanism for recurrent mitral regurgitation was largely mitral valve leaflet tethering. Our model (including age, body mass index, sex, race, effective regurgitant orifice area, basal aneurysm/dyskinesis, New York Heart Association class, history of coronary artery bypass grafting, percutaneous coronary intervention, or ventricular arrhythmias) yielded an area under the receiver operating characteristic curve of 0.82.


The model demonstrated good discrimination in identifying patients who will survive 2 years without recurrent mitral regurgitation after mitral valve repair. Although our results require validation, they offer a clinically relevant risk score for selection of surgical candidates for this procedure.


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