Valve Repair in Rheumatic Mitral Disease: An Unsolved Problem

UNLABELLED: Etiology plays an important role in the results of mitral valve repair. Although it is known that rheumatic disease is a negative factor, the possible influence of age has not been determined. In an attempt to study this factor, all consecutive Saudi patients operated for rheumatic mitral disease between July 1988 and December 1992 were reviewed. There were 537 patients (mean age 31.91 years). Replacement was performed in 231 patients and repair in 306. Follow-up was 98% complete with a maximum of 52 months (mean 20 months). The patients were divided by age into three groups: group I between 0 and 20 years (n = 145), group II between 21 and 40 years (n = 247), and group III older than 41 years (n = 145). The results showed repair rates of 76.6% (group I), 59.1% (group II), and 33.8% (group III). Actuarial survivals for repair were 95.87% (group I), 94.82% (group II), and 81.14% (group III), and for replacement were 88.33% (group I), 94.29% (group II), and 71.10% (group III). The reoperation rates for repair were 23.6% (group I), 9.6% (group II), and 8.7% (group III). There were only three reoperations in the replacement group. CONCLUSION: (1) the rate of repair is age dependent and inversely related; (2) repair in patients younger than 20 years of age carries a high reoperation rate; and (3) in this age group there is a higher survival tendency.