Valvular & structural heart disease
Midterm outcomes of rheumatic mitral valve repair versus replacement in a dual-centre retrospective study
Authors' conclusion
In well-selected patients, rheumatic mitral valve repair was associated with lower mortality and stroke rates compared with replacement, with comparable reoperation rates. However, patients with a history of percutaneous mitral commissurotomy have a higher risk of reoperation after repair and should be carefully evaluated.
Study context
- Population
- Patients undergoing rheumatic mitral valve surgery at two centres, excluding those with missing imaging or clinical data621 (63.9%) successfully underwent mitral valve repair
- Participants
- 972 patients
- Exposure
- Mitral repair versus replacement
- Repair groupn = 621
- Outcome
- Independent factors affecting repairability
Methodological detailsdual-centre, consecutively enrolled, inverse probability weighting
- Dual-centre
- Consecutively enrolled
- Inverse probability weighting
Main finding
As reported in the abstract
- Body mass index, diabetes, left atrial diameter, posterior leaflet calcification, anterior leaflet clear zone calcification and annular calcification were identified as independent factors affecting repairability
Observational data: associations, not effects.
Further findings
Prior percutaneous mitral commissurotomy and valve repairability
| OR (95% CI) | P value | ||
|---|---|---|---|
| Prior percutaneous mitral commissurotomyDid not reduce valve repairability | 0.588 (0.342–1.010) | P = 0.054 | |
| 0.20.5125Odds ratio (log scale) |
Prior percutaneous mitral commissurotomy and reoperation following repair
| OR (95% CI) | P value | ||
|---|---|---|---|
| Prior percutaneous mitral commissurotomyIndependent predictor of reoperation following repair | 7.496 (1.325–42.404) | P = 0.023 | |
| 0.050.21520Odds ratio (log scale) |
Mortality, stroke and reoperation rates · median follow-up of 3.51 years (IQR 1.62-5.14)
- Significantly reduced mortality and stroke rates in the repair group compared with the replacement group
- Comparable reoperation rates
Original publication
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