Valve repair in rheumatic mitral disease

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Repair
• Rheumatic Heart Disease

Background:

• Etiology significantly influences mitral valve repair outcomes.
• Rheumatic heart disease is a common cause of mitral valve pathology requiring intervention.
• Evaluating repair feasibility in a rheumatic population is crucial for surgical decision-making.

Purpose of the Study:

• To assess the possibilities and challenges of mitral valve repair in patients with rheumatic heart disease.
• To compare outcomes of mitral valve repair versus replacement in this specific patient cohort.

Main Methods:

• Retrospective review of 304 consecutive patients undergoing mitral valve surgery between July 1988 and July 1990.
• Categorization into mitral valve replacement (MVR), repair with subsequent replacement (attempts), and successful repair (repair) groups.
• Analysis of patient demographics, procedural outcomes, mortality, embolism rates, and reoperation incidence.

Main Results:

• Successful mitral valve repair was achieved in 65.7% of patients, with a higher rate in regurgitant lesions (79.4%).
• The repair group was younger and had less tricuspid valve involvement.
• Total hospital mortality was 3.2%, with significantly lower rates for successful repair (1.0%) compared to MVR (3.8%) and attempts (19.2%). Reoperation was needed in 12.1% of surviving repairs, particularly in patients under 20.

Conclusions:

• Mitral valve repair is feasible and associated with favorable short-term survival in selected rheumatic heart disease patients.
• Younger age and regurgitant lesions are predictive of successful repair.
• While reoperation rates for mitral repair dysfunction exist, particularly in the young, overall survival is superior to prosthetic replacement.