Mitral Valve Repair in Young Rheumatic Patients

Pomerantzeff, Pablo Maria Alberto

doi:10.5935/abc.20190215

Cited by 2 publications

(2 citation statements)

References 3 publications

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“…Although reconstruction is technically possible when the anterior leaflet is thickened, the repaired valve will most likely become stenotic in the long term. Moreover, an adequate zone of coaptation between the anterior and posterior leaflets is also crucial (41). Therefore, patients having the appropriate surgical indications is essential for achieving positive long-term results in MVP.…”

Section: Mvp and Mvr Are Two Independent Therapeuticmentioning

confidence: 99%

Clinical outcomes following surgical mitral valve repair or replacement in patients with rheumatic heart disease: a meta-analysis

Jiang¹,

Wang²,

Li³

et al. 2021

Ann Transl Med

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Background: The clinical outcome of mitral valve repair (MVP) is considerably more favorable than that of mitral valve replacement (MVR) in patients with degenerative mitral disease. However, rheumatic heart disease (RHD) is still the predominant cause of mitral valve surgery in developing countries and the advantages of MVP in RHD have still not been definitely proven. The aim of this meta-analysis was thus to evaluate the suitability of MVP in patients with RHD. Considering the difference between mechanical and biological valves, we distinguished them from each other and compared them with MVP individually. Methods: A comparison of clinical outcomes of MVP and MVR in patients with RHD was performed based on clinical trial data. Relevant articles published from January 1, 1990 until March 1, 2020 were identified in Pubmed, Cochrane Library, and China National Knowledge Infrastructure database (CNKI).Studies that lacked direct comparisons between MVP and MVR were excluded.Results: A total of 16 studies with 8659 patients were included in the analysis. The MVP group displayed lower early and long-term mortality, and fewer valve-related events and major adverse events. However, this patient group required more reoperations compared with the MVR group. Similar results were observed after distinguishing between mechanical and bioprosthetic valves to compare MVP with MVR (mech-valves), but no statistically significant difference was identified in the reoperation rate between MVP and MVR (bio-valves). MVP was further associated with increased risk of mitral reoperation in patients undergoing concomitant aortic valve replacement (AVR) surgery but without any improved early and long-term survival.Conclusions: MVP and MVR are beneficial for patients with RHD. For skilled surgeons, MVP can be performed for some suitable patients with RHD and is preferred for elderly patients or patients with contraindications of anticoagulation. However, MVR is more appropriate when concomitant AVR is needed.

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Section: Mvp and Mvr Are Two Independent Therapeuticmentioning

confidence: 99%

Clinical outcomes following surgical mitral valve repair or replacement in patients with rheumatic heart disease: a meta-analysis

Jiang¹,

Wang²,

Li³

et al. 2021

Ann Transl Med

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“…However, as degenerative mitral valve diseases became more frequent, comparisons of surgery results for both pathological types were inevitable and rheumatic series mostly came in second, with worse long-term outcomes, especially in series predominantly with younger patients. However, MVRep almost always performed better in comparison to replacement, even in these circumstances [ 10 ] .…”

Section: Introductionmentioning

confidence: 99%

The Global Burden of Rheumatic Heart Disease: Population-Related Differences (It is Not All the Same!)

Antunes¹

2020

Braz J Cardiovasc Surg

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Rheumatic heart disease (RHD) remains the most common cardiovascular disease in young adults and adolescents in need of heart surgery in low- and middle-income countries (LMICs). The mean age of patients is 20-25 years, often much younger. By contrast, the few patients with chronic RHD in developed countries present a mean age of around 55 years. It is absolutely fundamental to differentiate these two types of population. Pathology, lesions and surgical methods are different, and the results should not be compared. It is not all the same! A certain enthusiasm for mitral repair has recently surged, with several reports showing excellent results in children and young adults, resulting from the renewed interest of cardiac surgeons, also based on new and modified techniques developed in the meantime. While surgery is easily accessible to patients in developed countries, the situation in LMICs is often dramatic, with countries where there is a complete absence of or few surgical facilities absolutely unable to meet gigantic demands. Many foreign surgical teams conduct humanitarian missions in several of these countries. They are just a “drop of water in the ocean” of needs. In some cases, however, these missions led to the establishment of local teams that now work independently and, in some cases, outperform the foreign teams still visiting.

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Mitral Valve Repair in Young Rheumatic Patients

Cited by 2 publications

References 3 publications

Clinical outcomes following surgical mitral valve repair or replacement in patients with rheumatic heart disease: a meta-analysis

Clinical outcomes following surgical mitral valve repair or replacement in patients with rheumatic heart disease: a meta-analysis

The Global Burden of Rheumatic Heart Disease: Population-Related Differences (It is Not All the Same!)

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