Mitral valve procedure selection and outcomes in patients with rheumatoid arthritis

Cardiovascular disease is a frequent cause of death in patients with rheumatoid arthritis (RA). Valvular involvement is common, most frequently affecting the mitral valve. Whether RA is an additional risk factor for patients undergoing mitral surgery has not been studied. The study aim was to examine procedure selection and outcome in patients with RA compared to that in patients without RA.

The 2005-2008 NIS database was searched to identify patients aged > or = 18 years undergoing isolated mitral valve repair or replacement. Patients with and without RA were compared on their baseline characteristics and hospital outcomes. Within the subset of patients with RA, patients undergoing repair and replacement were compared.

RA patients comprised 1.0% (710/70,969) of the population, and were older, more likely to be female, and had a higher Charlson comorbidity index. The repair rate for RA patients was lower (37.6% versus 45.5%, p = 0.0401). The hospital length of stay (OR = 1.27, 95% CI 0.88-1.82, p = 0.1946) and hospital mortality (OR = 0.57, 95% CI 0.19-1.72, p = 0.3081) were similar for patients with and without RA. Baseline characteristics were similar between mitral valve repair and replacement subsets. The median LOS was higher for replacement (10 days versus 7 days, p = 0.0242). Hospital mortality was similar for repair versus replacement (OR = 1.17, 95% CI 0.10-13.46, p = 0.8983).

RA does not appear to be an additional risk factor for adverse outcome following isolated mitral valve surgery. Although repair rates were lower for patients with RA, hospital mortality was similar to that in patients without RA. Within the RA subset, hospital mortality rates between mitral valve repair and replacement were similar.