Comparison of Repair vs Replacement in Calcific and Rheumatic Mitral Disease

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Disease
• Rheumatic Heart Disease

Background:

• The optimal treatment strategy for rheumatic or calcified mitral valve disease, repair versus replacement, remains a subject of debate.
• Understanding long-term outcomes is crucial for guiding clinical decision-making.

Purpose of the Study:

• To compare the long-term survival and reoperation rates between mitral valve (MV) repair and replacement in patients with rheumatic or calcified MV disease.
• To investigate the impact of mitral stenosis on the outcomes of MV repair versus replacement.

Main Methods:

• A retrospective analysis of 4338 patients undergoing MV repair or replacement for rheumatic or calcified MV disease (2006-2020) from the Polish National Registry of Cardiac Surgery Procedures.
• Exclusion of patients with additional complex procedures, redo, or emergency surgeries.
• Long-term survival and reoperation data were analyzed using National Health Fund registry data, with comparisons made between repair and replacement groups, including propensity score-matched cohorts.

Main Results:

• Mitral valve repair demonstrated improved survival in patients without mitral stenosis (hazard ratio 0.81; P = .022).
• No significant survival benefit was observed for MV repair in patients with mitral stenosis (hazard ratio 1.17; P = .332).
• Ten-year freedom from reoperation was comparable between repair and replacement in both stenosis and non-stenosis groups, though trends suggested higher reoperation rates after repair in the stenosis group.

Conclusions:

• Mitral valve repair is a preferred option for rheumatic/calcified mitral valve disease in patients without mitral stenosis, associated with improved long-term survival.
• In the presence of mitral stenosis, mitral valve repair confers no survival benefit compared to replacement, indicating replacement may be a more suitable alternative.