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Rheumatic Mitral Valve Surgery: Repair or Replacement?
Luís Henrique Oliveira Pereira1, Kelvin Câmara1, Tamires Santos Pinheiro1
1Department of Medicine, Faculdade de Medicina, Universidade Centro de Ensino de Maringá (UNICESUMAR), Maringá, Paraná, Brazil.
Brazilian Journal of Cardiovascular Surgery
|February 17, 2025
Summary
Mitral valve repair offers better outcomes than replacement for rheumatic heart disease, with lower mortality and fewer complications. Survival and reoperation rates were similar between the two procedures.
Area of Science:
- Cardiology
- Public Health
- Surgical Outcomes
Background:
- Rheumatic heart disease (RHD) is a significant public health issue, particularly in developing nations.
- The mitral valve (MV) is frequently impacted by RHD, often necessitating surgical intervention.
- A debate exists regarding the optimal treatment: mitral valve repair versus replacement.
Purpose of the Study:
- To conduct a systematic review comparing patient survival after rheumatic mitral valve (MV) repair versus replacement.
- To analyze complication rates and reoperation necessity for both MV repair and replacement procedures.
Main Methods:
- Systematic literature review of English-language studies from January 2021 to February 2022.
- Databases searched included PubMed, LILACS, SciELO, and Google Scholar, adhering to PRISMA guidelines.
- Included studies involved at least 30 patients undergoing either MV repair or replacement for rheumatic disease.
Main Results:
- Analysis of six studies encompassing 2874 patients (69.6% female; age range 11–66 years).
- Mitral valve repair group: 2.5% mortality, 3.7% reoperation rate.
- Mitral valve replacement group: 8.2% mortality, 3.6% reoperation rate. Overall survival was comparable (85% repair vs. 87% replacement).
Conclusions:
- Mitral valve repair demonstrated lower mortality and complication rates compared to mitral valve replacement.
- Reoperation rates and patient survival were similar between the mitral valve repair and replacement groups.
- Mitral valve repair may be a preferable option for patients with rheumatic heart disease, considering the observed differences in mortality and complications.
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