Mitral valve repair and replacement for rheumatic disease

Objectives: Mitral valve repair may be technically feasible in patients wit h suitable anatomy, but the appropriateness of repair for rheumatic disease remains controversial. We evaluated our late outcomes after mitral repair and replacement for rheumatic disease. Methods: Five hundred seventy-three patients underwent mitral valve surgery for rheumatic disease at our instit ution from 1978-1995. Follow-up was 98% complete (mean, 68 +/- 46 months). Survival and morbidity were evaluated by Kaplan-Meier analysis and Cox regr ession, including propensity score analysis. Results: Mean age was 54 +/- 1 4 years, 55% of patients had congestive heart failure, 22% were undergoing redo mitral valve surgery, and 9% also underwent coronary bypass. Mitral st enosis was present in 53%, regurgitation in 15%, and both in 32%. Valve rep air was performed in 25%, bioprosthetic replacement was performed in 28%, a nd a mechanical valve was placed in 47%, Patients undergoing repair were yo unger and less likely to be undergoing reoperation or to have atrial fibril lation than those undergoing replacement (P =.001). The operative mortality rate was 4.2%, Better late cardiac survival was independently predicted by valve repair rather than replacement (P =.04) after adjustment for baselin e differences between patients. Freedom from reoperation was greatest (P =. 005) but that from thromboembolic complications was worst (P =.0001) after mechanical valve replacement. Twenty-three patients underwent reoperation a fter initial repair, with no operative deaths. Conclusions: Mechanical valv es minimize reoperation but limit survival and increase thromboembolic comp lications. Patients undergoing valve repair had improved late cardiac survi val independent of their preoperative characteristics. Rheumatic mitral val ves should be repaired when technically feasible, accepting a risk of reope ration, to maximize survival and reduce morbidity.