Two-Year Outcomes of Surgical Treatment of Severe XXXX .

@entity1 @entity712 @entity204 @entity339
BACKGROUND: In a randomized trial comparing mitral-valve repair with mitral-valve replacement in @entity1 with severe @entity339 , we found no significant difference in the left ventricular end-systolic volume index (LVESVI), survival, or adverse events at 1 year after surgery. However, @entity1 in the repair group had significantly more recurrences of moderate or severe @entity339 . We now report the 2-year outcomes of this trial. METHODS: We randomly assigned 251 @entity1 to mitral-valve repair or replacement. @entity1 were followed for 2 years, and clinical and echocardiographic outcomes were assessed. RESULTS: Among surviving @entity1 , 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 @entity204 ) showed no significant between-group difference (z score=-1.32, P=0.19). The rate of recurrence of moderate or severe @entity339 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 @entity1 in the repair group had more serious adverse events related to @entity712 (P=0.05) and cardiovascular readmissions (P=0.01). On the Minnesota Living with @entity712 questionnaire, there was a trend toward greater improvement in the replacement group (P=0.07). CONCLUSIONS: In @entity1 undergoing mitral-valve repair or replacement for severe @entity339 , we observed no significant between-group difference in left ventricular reverse remodeling or survival at 2 years. @entity339 recurred more frequently in the repair group, resulting in more @entity712 -related adverse events and cardiovascular admissions. (Funded by the National Institutes of Health and Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00807040.).
