Objective Unlike degenerative mitral valve (MV) disease, the advantages of valve repair procedure over replacement have been debated in rheumatic MV disease. This study aims to evaluate the impact of procedural types on long-term outcomes through analyses on a large data set from an endemic area of rheumatic disease.
Methods We evaluated 1731 consecutive patients (52.3±12.5 years; 1190 women) undergoing MV surgery for rheumatic MV disease between 1997 and 2015. Long-term survival and valve-related outcomes were compared between repair and replacement procedures. To adjust for selection bias, propensity score analyses were performed.
Results Patients undergoing repair were younger and had more predominant mitral regurgitation than mechanical and bioprosthetic replacement groups (61.6% vs 15.6% vs 24.4%; P<0.001). During follow-up (130.9±27.7 months), 283 patients (16.3%) died and 256 patients (14.8%) experienced valve-related complications. Propensity score matching yielded 188 pairs of repair and replacement patients that were well balanced for baseline covariates. In the matched cohort, there was no significant difference in the mortality risk between the repair and replacement groups (HR, 1.24; 95% CI 0.62 to 2.48). The risk of composite valve-related complications, however, was significantly lower in repair group (HR, 0.57; 95% CI 0.33 to 0.99) principally derived by a lower risk of haemorrhagic events (HR, 0.23; 95% CI 0.07 to 0.70). The incidence of reoperation was not significantly different between groups in the matched cohort (HR, 1.62; 95% CI 0.49 to 5.28).
Conclusion Valve repair in well-selected patients with severe rheumatic MV disease led to comparable survival, but superior valve-related outcomes compared with valve replacement surgery.
- mitral stenosis
- mitral regurgitation
- valve disease surgery
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Contributors JBK conceived the present study. JBK, SHJ and WKK performed statistical analyses. JBK and JWL handled funding and supervision. WKK, SJC and CHC acquired the data of present study. WKK drafted the manuscript. JBK made critical revision of the manuscript for key intellectual content.
Funding This study was supported by a grant from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea.
Competing interests None declared.
Ethics approval The study protocol was approved by the Institutional Review Board of the Asan Medical Center.
Provenance and peer review Not commissioned; externally peer reviewed.