Valve repair in rheumatic mitral disease: an unsolved problem

Area of Science:

• Cardiology
• Cardiac Surgery
• Valvular Heart Disease

Background:

• Rheumatic heart disease is a known negative prognostic factor for mitral valve repair.
• The influence of patient age on mitral valve repair outcomes, particularly in rheumatic disease, requires further investigation.

Purpose of the Study:

• To evaluate the impact of age on the success rates and long-term outcomes of mitral valve repair in Saudi patients with rheumatic mitral disease.

Main Methods:

• A retrospective review of 537 Saudi patients undergoing mitral valve surgery for rheumatic disease between 1988 and 1992.
• Patients were stratified into three age groups: 0-20 years, 21-40 years, and >41 years.
• Surgical outcomes including repair rates, survival, and reoperation rates were analyzed across age groups.

Main Results:

• Mitral valve repair rates decreased with increasing age (76.6% in 0-20 years, 59.1% in 21-40 years, 33.8% in >41 years).
• Actuarial survival was highest for repair in the youngest group (95.87%) but reoperation rates were also highest (23.6%).
• Replacement showed comparable survival to repair in the middle age group but lower survival in the youngest and oldest groups.

Conclusions:

• The rate of successful mitral valve repair is inversely related to patient age.
• Repair in patients under 20 years old is associated with a high reoperation rate, despite a favorable survival tendency.
• Age is a critical factor influencing the choice between mitral valve repair and replacement in rheumatic heart disease.