Kim WK, et al. - Researchers sought to determine the effect of procedural types on long-term outcomes in patients undergoing mitral valve (MV) surgery for rheumatic valve disease. For this purpose, a large data set from an endemic area of rheumatic disease were analyzed. As compared with valve replacement surgery, valve repair afforded comparable survival but superior valve-related outcomes when performed in well-selected patients with severe rheumatic MV disease.

Methods

• A total of 1731 consecutive patients (52.3±12.5 years; 1190 women) undergoing MV surgery for rheumatic MV disease between 1997 and 2015 were assessed in this study.
• A comparison was performed of long-term survival and valve-related outcomes between repair and replacement procedures.
• Furthermore, propensity score analyses were performed to adjust for selection bias.

Results

• Findings demonstrated that patients undergoing repair were younger and had more predominant mitral regurgitation as compared with mechanical and bioprosthetic replacement groups (61.6% vs 15.6% vs 24.4%; P<0.001).
• During follow-up (130.9±27.7 months), death was reported in 283 patients (16.3%) and valve-related complications were experienced by 256 patients (14.8%).
• In addition, propensity score matching yielded 188 pairs of repair and replacement patients that were well balanced for baseline covariates.
• In the matched cohort, the repair and replacement groups did not significantly differ in terms of mortality risk (HR, 1.24; 95% CI 0.62 to 2.48).
• Researchers found that 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).
• Between groups in the matched cohort, no significant difference was noted in the incidence of reoperation (HR, 1.62; 95% CI 0.49 to 5.28).