HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Terrence M. Yau Tirone E. David Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Yau, T. M. Articles by David, T. E. Search for Related Content PubMed PubMed Citation Articles by Yau, T. M. Articles by David, T. E.

J Thorac Cardiovasc Surg 2000;119:53-061
© 2000 Mosby, Inc.

SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE

MITRAL VALVE REPAIR AND REPLACEMENT FOR RHEUMATIC DISEASE

From the Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

Address for reprints: Terrence M. Yau, MD, MSc, 13EN-239, Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario M5G 2C4, Canada (E-mail: terry.yau{at}utoronto.ca).

Objectives: Mitral valve repair may be technically feasible in patients with 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 institution from 1978-1995. Follow-up was 98% complete (mean, 68 ± 46 months). Survival and morbidity were evaluated by Kaplan-Meier analysis and Cox regression, including propensity score analysis.
Results: Mean age was 54 ± 14 years, 55% of patients had congestive heart failure, 22% were undergoing redo mitral valve surgery, and 9% also underwent coronary bypass. Mitral stenosis was present in 53%, regurgitation in 15%, and both in 32%. Valve repair was performed in 25%, bioprosthetic replacement was performed in 28%, and a mechanical valve was placed in 47%. Patients undergoing repair were younger and less likely to be undergoing reoperation or to have atrial fibrillation 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 baseline 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 after initial repair, with no operative deaths.
Conclusions: Mechanical valves minimize reoperation but limit survival and increase thromboembolic complications. Patients undergoing valve repair had improved late cardiac survival independent of their preoperative characteristics. Rheumatic mitral valves should be repaired when technically feasible, accepting a risk of reoperation, to maximize survival and reduce morbidity.

This article has been cited by other articles:

				B. El Oumeiri, M. Boodhwani, D. Glineur, L. De Kerchove, A. Poncelet, P. Astarci, A. Pasquet, J.-L. Vanoverschelde, R. Verhelst, J. Rubay, et al. Extending the Scope of Mitral Valve Repair in Rheumatic Disease. Ann. Thorac. Surg., June 1, 2009; 87(6): 1735 - 1740. [Abstract] [Full Text] [PDF]

				W. R. E. Jamieson, V. M. Gudas, L. H. Burr, M. T. Janusz, G. J. Fradet, H. Ling, E. Germann, and S. V. Lichtenstein Mitral valve disease: if the mitral valve is not reparable/failed repair, is bioprosthesis suitable for replacement? Eur. J. Cardiothorac. Surg., January 1, 2009; 35(1): 104 - 110. [Abstract] [Full Text] [PDF]

				A. Kalangos, J. T. Christenson, M. Beghetti, M. Cikirikcioglu, D. Kamentsidis, and Y. Aggoun Mitral Valve Repair for Rheumatic Valve Disease in Children: Midterm Results and Impact of the Use of a Biodegradable Mitral Ring Ann. Thorac. Surg., July 1, 2008; 86(1): 161 - 169. [Abstract] [Full Text] [PDF]

				F. Y. Chen and L. H. Cohn Mitral Valve Repair Card. Surg. Adult, January 1, 2008; 3(2008): 1013 - 1030. [Full Text]

				V. T Nkomo Epidemiology and prevention of valvular heart diseases and infective endocarditis in Africa Heart, December 1, 2007; 93(12): 1510 - 1519. [Abstract] [Full Text] [PDF]

				J. J. Jokinen, M. J. Hippelainen, O. A. Pitkanen, and J. E.K. Hartikainen Mitral Valve Replacement Versus Repair: Propensity-Adjusted Survival and Quality-of-Life Analysis Ann. Thorac. Surg., August 1, 2007; 84(2): 451 - 458. [Abstract] [Full Text] [PDF]

				B.-C. Chang, Y.-N. Youn, J.-W. Ha, S.-H. Lim, Y.-S. Hong, and N. Chung Long-term clinical results of mitral valvuloplasty using flexible and rigid rings: A prospective and randomized study J. Thorac. Cardiovasc. Surg., April 1, 2007; 133(4): 995 - 1003. [Abstract] [Full Text] [PDF]

				K. Kuwaki, N. Kawaharada, K. Morishita, T. Koyanagi, H. Osawa, T. Maeda, and T. Higami Mitral Valve Repair Versus Replacement in Simultaneous Mitral and Aortic Valve Surgery for Rheumatic Disease Ann. Thorac. Surg., February 1, 2007; 83(2): 558 - 563. [Abstract] [Full Text] [PDF]

				J. Shuhaiber and R. J. Anderson Meta-analysis of clinical outcomes following surgical mitral valve repair or replacement Eur. J. Cardiothorac. Surg., February 1, 2007; 31(2): 267 - 275. [Abstract] [Full Text] [PDF]

				S M Tuladhar and P P Punjabi Surgical reconstruction of the mitral valve Heart, October 1, 2006; 92(10): 1373 - 1377. [Abstract] [Full Text] [PDF]

				J M Ferrao de Oliveira and M. J Antunes Mitral valve repair: better than replacement Heart, February 1, 2006; 92(2): 275 - 281. [Full Text] [PDF]

				G. Doukas, N. J. Samani, C. Alexiou, M. Oc, D. T. Chin, P. G. Stafford, L. L. Ng, and T. J. Spyt Left Atrial Radiofrequency Ablation During Mitral Valve Surgery for Continuous Atrial Fibrillation: A Randomized Controlled Trial JAMA, November 9, 2005; 294(18): 2323 - 2329. [Abstract] [Full Text] [PDF]

				H. T. Sie, W. P. Beukema, A. Elvan, and A. R. Ramdat Misier Long-term results of irrigated radiofrequency modified maze procedure in 200 patients with concomitant cardiac surgery: six years experience Ann. Thorac. Surg., February 1, 2004; 77(2): 512 - 517. [Abstract] [Full Text] [PDF]

				H. T Sie, W. P Beukema, A. Elvan, and A. R Ramdat Misier New strategies in the surgical treatment of atrial fibrillation Cardiovasc Res, June 1, 2003; 58(3): 501 - 509. [Abstract] [Full Text] [PDF]

				T. E. David, J. Ivanov, S. Armstrong, and H. Rakowski Late outcomes of mitral valve repair for floppy valves: Implications for asymptomatic patients J. Thorac. Cardiovasc. Surg., May 1, 2003; 125(5): 1143 - 1152. [Abstract] [Full Text] [PDF]

				A. M. Gillinov and D. M. Cosgrove III Mitral Valve Repair Card. Surg. Adult, January 1, 2003; 2(2003): 933 - 950. [Full Text]

				M. F. Ibrahim and T. E. David Mitral stenosis after mitral valve repair for non-rheumatic mitral regurgitation Ann. Thorac. Surg., January 1, 2002; 73(1): 34 - 36. [Abstract] [Full Text] [PDF]

				O. Alfieri, F. Maisano, M. De Bonis, P. L. Stefano, L. Torracca, M. Oppizzi, and G. La Canna The double-orifice technique in mitral valve repair: A simple solution for complex problems J. Thorac. Cardiovasc. Surg., October 1, 2001; 122(4): 674 - 681. [Abstract] [Full Text] [PDF]

				H. T. Sie, W. P. Beukema, A. R. R. Misier, A. Elvan, J. J. Ennema, M. M.P. Haalebos, and H. J.J. Wellens Radiofrequency modified maze in patients with atrial fibrillation undergoing concomitant cardiac surgery J. Thorac. Cardiovasc. Surg., August 1, 2001; 122(2): 249 - 256. [Abstract] [Full Text] [PDF]

				C.-K. Ng, J. Nesser, C. Punzengruber, O. Pachinger, J. Auer, H. Franke, and P. Hartl Valvuloplasty with glutaraldehyde-treated autologous pericardium in patients with complex mitral valve pathology Ann. Thorac. Surg., January 1, 2001; 71(1): 78 - 85. [Abstract] [Full Text] [PDF]