Mitral Valve Surgery for Rheumatic Lesions in Young Patients

Abstract

Background: The appropriateness of rheumatic mitral valve repair remains controversial due to the risks of recurrent mitral dysfunction and need for reoperation. The aims of this study were to determine the overall short-and long-term outcomes of pediatric rheumatic mitral valve surgery in our center. Methods: Single-center, observational, retrospective study that analyzed the results of rheumatic mitral valve surgery in young patients, consecutively operated by the same team, between 1999 and 2014. Results: We included 116 patients (mean age ¼ 12.6 + 3.5 years), of which 66 (57%) were females. A total of 116 primary surgical interventions and 22 reoperations were performed. Primary valve repair was possible in 86 (74%) patients and valve replacement occurred in 30 (26%). Sixty percent of the patients were followed up beyond three months after surgery (median follow-up time ¼ 9.2 months [minimum ¼ 10 days; maximum ¼ 15 years]). Long-term clinical outcomes were favorable, with most patients in New York Heart Association functional class I (89.6%) and in sinus rhythm (85%). Freedom from reoperation for primary valve repair at six months, five years, and ten years was 96.4% + 0.25%, 72% + 0.72%, and 44.7% + 1.34%, respectively. Freedom from reoperation for primary valve replacement at six months, five years, and ten years was 100%, 91.7% + 0.86%, and 91.7% + 0.86%, respectively. Mitral stenosis as the primary lesion dictated early reintervention. Conclusions: Despite the greater rate of reoperation, especially when the primary lesion was mitral stenosis, rheumatic mitral valve repair provides similar clinical outcomes as compared with replacement, with the advantage of avoiding anticoagulation.

Cardiac surgery in Africa: a thirty-five year experience on open heart surgery in Cote d’Ivoire

“…Those results are not different from Remenyi et al (31) experience with a significant advantage of valve repair as he has demonstrated an actuarial freedom from valve related complications at 10 and 14 years at 63% and 45% for patients with valvular replacement compared to 100% and 100% for patients with valve repair. Even if valvuloplasty provides better long term results, we also noted in our study that valve replacement can be useful as reminded by Cardoso et al (32) who reported an excellent rate of freedom from reintervention for primary valve replacement at 6 months, 5 years, 10 years at 100%, 91.7% and 91.7% respectively versus 96.4%, 72%, 44% at 6 months, 5 years, 10 years respectively after primary valve repair. To avoid valve replacement and to get greater opportunity for valve repair and percutaneous balloon valvuloplasty, Russell (33) in her review of valve surgery for RHD in Australia on patients has recommended earlier referral prior to the establishment of valvular fibrosis and calcifications and earlier surgical management.…”

Repair versus replacement of mitral valves in cases of severe rheumatic mitral stenosis: mid-term clinical outcomes

“…In the limited reports on the repair of the rheumatic mitral valve, the majority of rheumatic mitral valve lesions were regurgitation (10,19). Our data was different.…”

“…There were only 349 cases in moderate (or more) mitral valve regurgitation, accounting for just 37.9% of the 921 cases. Also, unlike previous studies (10,(19)(20)(21), our study had a predominantly female population (2.89:1 female vs. male ratio), with a higher average age (54.06 years old), and a higher incidence of atrial fibrillation (694/921, 75.4%); in general, it was more severe in rheumatic mitral lesions.…”

Predictors of Unfavourable Outcomes in Children and Adolescents Submitted to Surgical Mitral Valvuloplasty Secondary to Chronic Rheumatic Heart Disease

“…MVP is universally accepted as superior to valve replacement (bioprostheses or metal prostheses), especially in children in whom growth, problems with anticoagulation, thromboembolism, rapid valve degeneration, increased risk of endocarditis and less preservation of ventricular function are unfavourable factors to this technique. [6][7][8][10][11][12] In the tertiary hospital in which the study was performed, MVP is the preferred technique.…”

“…This is in accordance with the literature, in which the precocious or hospital mortality rate ranged from 0.9 to 3.5%. 7,12,13 The literature lacks in studies that identify probable clinical predictors of negative outcomes in patients undergoing MVP surgery. In the present study, PH presented statistical significance for both immediate (≤7 days) and late (up to 60 days) postoperative outcomes in the univariate analysis, but did not maintain significance in the multivariate analysis.…”