Mitral valve repair for rheumatic mitral regurgitation: Mid-term results

Waikittipong, Somchai

doi:10.1177/0218492315576282

Cited by 20 publications

(15 citation statements)

References 9 publications

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“…These authors extracted data from seven selected studies, performed a pooled analysis and showed that the MV repair group has lower 30-day mortality, higher long-term survival, fewer postoperative major adverse events than the MV replacement group, while displaying an acceptable reoperation rate. Another study (11) suggested MV repair is a better alternative to valve replacement for RHD patients, corroborating the findings in the current meta-analysis. Pooled analysis showed that freedom from adverse events in patients after rheumatic MV repair surgery was 97.5% (95% CI, 95.2-99.8%).…”

Section: Discussionsupporting

confidence: 90%

A meta-analysis of late outcomes of mitral valve repair in patients with rheumatic heart disease

Fu¹,

Popal²,

Zhang³

et al. 2017

J. Thorac. Dis.

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Background: Rheumatic heart disease (RHD) is a predominant health concern in developing countries.The aim of this meta-analysis was to evaluate the outcomes of mitral valve (MV) repair in patients with RHD, and identify predictors that may postoperatively affect treatment outcome. Methods: A meta-analysis of eligible studies assessing patients undergoing MV repair with RHD and reporting the outcomes of MV repair, including 30-day mortality and long-term follow-up survival, MV reoperation rate and postoperative adverse events. Relevant English articles were searched up to 1 March, 2017 in Web of Science, PubMed, Google Scholar, Cochrane Library, EmBase, Elsevier, and Science Direct.Selected studies should meet all inclusion criteria, and underwent data extraction. Results: A total of ten studies with 2,770 patients met all inclusion criteria, and were selected for assessment. Pooled analysis showed that 30-day mortality in patients with rheumatic MV disease after MV repair surgery was 1.9%, 95% confidence interval (CI) (0.8-2.9%); long-term survival was 97.3%, 95% CI (95.9-98.6%), and a freedom from reoperation rate of 93.6%, 95% CI (91.4-95.9%) was obtained; freedom from adverse events was 97.5%, 95% CI (95.2-99.8%). Conclusions:The outcome of rheumatic MV repair is outstanding in terms of low early mortality, high long-term survival and freedom from valve-related complications, which may be very common in patients after rheumatic MV replacement; meanwhile, MV reoperation rate after initial surgery is acceptable. Surgeons may try to repair MV in RHD when it is feasibleKeywords: Rheumatic heart disease (RHD); mitral valve (MV) repair; outcomes; meta-analysis J Thorac Dis 2017;9(11):4366-4375 jtd.amegroups.com feasibility of MV repair for RHD patients is extremely low. However, other studies (3,4) believed that MV replacement may not be the most optimal surgical treatment for such patients, demonstrating the advantages of MV repair over replacement in terms of low rate of early mortality, better late survival, preservation of left ventricular function, and reduced anticoagulant-related complications. Here, we systematically reviewed published literature and performed a meta-analysis which assessed the outcomes of MV repair in patients with RHD, exploring predictive factors that may postoperatively affect treatment outcome. Methods Literature searchWeb of Science, PubMed, Cochrane Library, Google Scholar, EmBase, Elsevier, and ScienceDirect were independently searched by two authors (JT Fu, MS Popal) for potentially relevant studies which analyzed the outcomes of MV repair for rheumatic MV disease, up to 1 March, 2017. The following key terms were used either alone or in combination: "rheumatic heart disease", "RHD", "mitral valve repair", "MVP", "mitral valve reconstruction", and "mitral valve surgery". Some references in relevant studies were hand searched for additional articles which could not be identified by the advanced search. Selection criteriaThe inclusion criteria were: (I) directly analysis of MV repair...

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Section: Discussionsupporting

confidence: 90%

A meta-analysis of late outcomes of mitral valve repair in patients with rheumatic heart disease

Fu¹,

Popal²,

Zhang³

et al. 2017

J. Thorac. Dis.

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“…With two thirds of mitral patients over the age of forty showing degrees of leaflet thickening and rigidity [113], the repairable group is limited to a minority of the patients and even with sophisticated surgical techniques have high re-operation rates [114]. As such, prosthetic solutions need to resolve the dilemma of early degeneration in bioprosthetic valves [115] versus high thrombo-embolic complications [116] in mechanical valves for whom adherence is more challenging [117].…”

Section: Current Epidemiology Of Gas Arf and Rhd Around The Worldmentioning

confidence: 99%

Group A Streptococcus, Acute Rheumatic Fever and Rheumatic Heart Disease: Epidemiology and Clinical Considerations

Zühlke

Beaton

Engel

et al. 2017

Curr Treat Options Cardio Med

123

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Opinion statementEarly recognition of group A streptococcal pharyngitis and appropriate management with benzathine penicillin using local clinical prediction rules together with validated rapi-strep testing when available should be incorporated in primary health care. A directed approach to the differential diagnosis of acute rheumatic fever now includes the concept of low-risk versus medium-to-high risk populations. Initiation of secondary prophylaxis and the establishment of early medium to long-term care plans is a key aspect of the management of ARF. It is a requirement to identify high-risk individuals with RHD such as those with heart failure, pregnant women, and those with severe disease and multiple valve involvement. As penicillin is the mainstay of primary and secondary prevention, further research into penicillin supply chains, alternate preparations and modes of delivery is required.

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“…Dillon et al [70] reported 83.3 AE 4.3% 10-year survival and 98.4 AE 0.9% freedom from reoperation. Waikittipong [71] reports a very high rate of success for complex valve repair using primarily leaflet mobilization with chordal cutting, papillary muscle splitting, and commissurotomy for type IIIb restricted leaflet motion and neochords, chordal transfer, or shortening for type II leaflet prolapse. The author emphasizes three criteria for successful repair: selection of patients who are beyond the acute inflammatory phase with suitable morphology for repair; repair based on surgical principles of leaflet mobilization, correction of prolapse and ring annuloplasty; and secondary prophylaxis using penicillin.…”

Section: Interventional and Surgical Management Of Rheumatic Heart DImentioning

confidence: 99%

Update on rheumatic heart disease

Yanagawa

Butany

Verma

2016

Current Opinion in Cardiology

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Mitral valve repair for rheumatic mitral regurgitation: Mid-term results

Cited by 20 publications

References 9 publications

A meta-analysis of late outcomes of mitral valve repair in patients with rheumatic heart disease

A meta-analysis of late outcomes of mitral valve repair in patients with rheumatic heart disease

Group A Streptococcus, Acute Rheumatic Fever and Rheumatic Heart Disease: Epidemiology and Clinical Considerations

Update on rheumatic heart disease

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