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Mitral valve repair and replacement for rheumatic disease
T M Yau1, Y A El-Ghoneimi, S Armstrong
1Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. terry.yau@utoronto.ca
The Journal of Thoracic and Cardiovascular Surgery
|December 29, 1999
Summary
Mitral valve repair in rheumatic heart disease offers improved late survival compared to replacement. While repair may require reoperation, it maximizes survival and reduces morbidity when technically feasible.
Area of Science:
- Cardiovascular Surgery
- Valvular Heart Disease
- Rheumatic Heart Disease
Background:
- Rheumatic heart disease commonly affects the mitral valve.
- Mitral valve repair's role in rheumatic disease is debated.
- Late outcomes of mitral valve repair versus replacement for rheumatic disease require evaluation.
Purpose of the Study:
- To evaluate late outcomes after mitral valve repair and replacement for rheumatic disease.
- To compare survival and morbidity between mitral valve repair and replacement strategies.
- To determine the appropriateness of mitral valve repair for rheumatic mitral valve disease.
Main Methods:
- Retrospective analysis of 573 patients undergoing mitral valve surgery for rheumatic disease (1978-1995).
- Kaplan-Meier analysis and Cox regression, including propensity score analysis, for survival and morbidity.
- Detailed evaluation of valve repair, bioprosthetic replacement, and mechanical valve replacement outcomes.
Main Results:
- Operative mortality was 4.2%.
- Mitral valve repair was associated with independently predicted better late cardiac survival (P =.04).
- Mechanical valve replacement offered freedom from reoperation but increased thromboembolic complications.
Conclusions:
- Mitral valve repair in rheumatic heart disease improves late survival independent of preoperative factors.
- Repair should be considered when technically feasible to maximize survival and reduce morbidity.
- Mechanical valves reduce reoperation risk but compromise survival and increase thromboembolic events.