A feasibility study of valve repair in rheumatic mitral regurgitation

Durán, Carlos M.G.; Gometza, Begonia; Balasundaram, S.; Halees, Zohair Al

doi:10.1093/eurheartj/12.suppl_b.34

Cited by 17 publications

(8 citation statements)

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“…5,7,9,25,26) Although the results were slightly better in our repair versus replacement group, which contrasts with the significant superiority of the repair groups in other studies. However, in our series almost 95% of the patient population had atrial fibrillation and they were more likely to have suffered a stroke preoperatively.…”

Section: Discussioncontrasting

confidence: 97%

Midterm Outcomes of Rheumatic Mitral Repair Versus Replacement

et al. 2008

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SUMMARYMitral repair is feasible for patients with degenerative or ischemic heart disease, however, the appropriateness of repair for rheumatic heart disease remains controversial. We compared our outcomes for primary isolated mitral repair versus replacement in an elderly population. From November 1997 to July 2005, mitral repair (group I) was performed in 33 patients while 59 underwent replacement (group II). Survival and risk factors were evaluated by Kaplan-Meier and Cox regression analysis. Mean age at operation for groups I and II was 49.7 ± 13.2 versus 58.1 ± 11.2 (P = 0.002). No statistically significant differences with regards to demographic parameters were observed except for there being fewer percutaneous transvenous mitral commissurotomy procedures and a lower severity of pulmonary hypertension in group I. Patients with a greater Wilkins score and more valvular calcification underwent replacement more often (P < 0.001). In-hospital mortality, ICU/hospital stay, and postoperative congestive heart failure functional class did not differ significantly. Major adverse cardiac events occurred in 13 and 19 patients, respectively (P = 0.50). There were 4 versus 6 late deaths (P = 0.74). Only two from group I underwent subsequent mitral reoperation. Kaplan-Meier overall survival and event-free survival at 5 years for groups I and II were 0.81 ± 0.08 versus 0.81 ± 0.06 (P = 0.90) and 0.52 ± 0.10 versus 0.51 ± 0.10 (P = 0.21), respectively. Old age, renal insufficiency, LVEF < 40%, and a history of stroke were poor predictors of patient survival. Compared with replacement, mitral repair for rheumatic heart disease was associated with a lower surgical mortality, higher repeat-surgery rate, and good survival. Rheumatic mitral valves should be repaired in select patients with appropriate valvular pathology. (Int Heart J 2008; 49: 565-576)

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Section: Discussioncontrasting

confidence: 97%

Midterm Outcomes of Rheumatic Mitral Repair Versus Replacement

et al. 2008

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“…Patients with unfavorable morphology, such as significant stenosis (valve area <2.0 cm 2 ) or subvalvular calcification, underwent a straight valve replacement, and, during the study period, about 80% of the total patients with significant rheumatic mitral regurgitation were selected for repair after the echocardiographic screening. This may explain the relatively higher rate of successful repair of rheumatic mitral regurgitation in our study (92%) compared to 67% reported by others (19).…”

Section: Discussioncontrasting

confidence: 63%

Comparison of Clinical and Echocardiographic Outcomes After Valve Repair: Degenerative Versus Rheumatic Mitral Regurgitation

et al. 2003

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We compared clinical (30 24 months) and echocardiographic follow-up (22 20 months) data of 184 consecutive patients with myxomatous degenerative mitral regurgitation (Group A) and 85 consecutive patients with rheumatic mitral regurgitation (Group B) after repair. Selection criteria for rheumatic etiology was predominant mitral regurgitation with valve area 2.0 cm 2 and with no significant calcification in valvular apparatus. Repair was successful in 93% of group A and in 92% of group B (p>0.05). There was no difference of operative mortality (1% vs 0%) and of the incidence of the second-pump valve replacement (4% vs 5%). The 4-yr survival, 4-yr event-free survival, and 4-yr mitral regurgitationfree survival rates in group A were 96 2%, 89 4%, and 76 5%, respectively, which were not different from those in group B (97 2%, 93 4%, and 68 7%, p>0.05). Independent determinants of development of at least moderate regurgitation in group A were no use of ring annuloplasty (hazards ratio 6.6, 95% CI 2.0 to 21.5) and new chordae formation (hazards ratio 3.5, 95% CI 1.4 to 8.7). In group B, no use of ring annuloplasty (hazards ratio 15.3, 95% CI 3.5 to 66.7) also was independent predictor. Valve repair is highly feasible in selected patients with rheumatic mitral regurgitation, and clinical course is not significantly different from that of patients with degenerative mitral regurgitation.

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“…The noncompliance of this population to anticoagulation therapy must be considered in the choice of the treatment. This fact has been emphasized by Duran et al 17 and underlines the importance of a nonthrombogenic surgical procedure.…”

Section: Discussionmentioning

confidence: 85%

Long-Term (29 Years) Results of Reconstructive Surgery in Rheumatic Mitral Valve Insufficiency

Chauvaud

Fuzellier²,

Berrébi³

et al. 2001

Circulation

182

116

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Background-Results of conservative surgery are well established in degenerative mitral valve (MV) insufficiency.However, there are controversies in rheumatic disease. This study is the evaluation of one center for rheumatic MV insufficiency based on a functional approach. Methods and Results-From 1970 to 1994, 951 patients with rheumatic MV insufficiency were operated on with the reconstructive techniques elaborated by Alain Carpentier. Aortic valve diseases were excluded. Mean age was 25.8 years (4 to 75), and sinus rhythm was present in 63%. The functional classification used was type I, normal leaflet motion, 71 patients (7%); type II, prolapsed leaflet, 311 patients (33%); and type III, restricted leaflet motion, 345 patients (36%). The combined lesion of prolapse of the anterior leaflet and restriction of the posterior was present in 224 patients (24%). Surgical techniques used were implantation of a prosthetic ring in 95%, shortening of the chords and leaflet enlargement with autologous pericardium, and commissurotomy. Hospital mortality rate was 2%. The mean follow-up was 12 years (maximum, 29 years): 8618 patients per year. Actuarial survival was 89Ϯ19% at 10 years and 82Ϯ18% at 20 years. The rate of thromboembolic events was 0.4% patients per year (33 events), with 3 deaths. Freedom from reoperation was 82Ϯ19% at 10 years and 55Ϯ25% at 20 years. The main cause (83%) of reoperation was progressive fibrosis of the MV. The actuarial rate of reoperation was 2% patients per year and was correlated to the degree of preoperative fibrosis. Conclusions-Conservative

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A feasibility study of valve repair in rheumatic mitral regurgitation

Cited by 17 publications

References 0 publications

Midterm Outcomes of Rheumatic Mitral Repair Versus Replacement

Midterm Outcomes of Rheumatic Mitral Repair Versus Replacement

Comparison of Clinical and Echocardiographic Outcomes After Valve Repair: Degenerative Versus Rheumatic Mitral Regurgitation

Long-Term (29 Years) Results of Reconstructive Surgery in Rheumatic Mitral Valve Insufficiency

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