Key result
Rheumatic mitral valve repair significantly improved global longitudinal strain compared to posterior chordal-sparing replacement (-18.6% vs -16.2%, P<0.001) at 6 months.
Why the study?
Rheumatic mitral valve repair and replacement are frequently used with excellent outcomes in experienced centers, but the impact of procedural types on left ventricular function in quinquagenarians needed evaluation.
Does rheumatic mitral valve repair improve left ventricular function parameters compared to posterior chordal-sparing mitral valve replacement in quinquagenarian patients with severe rheumatic mitral stenosis?
Cohort (n=70)
Does rheumatic mitral valve repair improve left ventricular function parameters compared to posterior chordal-sparing mitral valve replacement in quinquagenarian patients with severe rheumatic mitral stenosis?
Absolute Event Rate: -18.6% vs -16.2%
p-value: p=<0.001
Rheumatic mitral valve repair is associated with better early postoperative left ventricular mechanics compared to posterior chordal-sparing replacement in patients with severe rheumatic mitral stenosis.
May favor repair to preserve LV strain in rheumatic mitral disease; hypothesis-generating, needs RCTs before practice change.
BACKGROUND: Rheumatic mitral valve repair and replacement techniques are frequently used with excellent outcomes in experienced centers. This study aims to evaluate the impact of procedural types on left ventricular function in quinquagenarians. METHODS: Between January 2018 and September 2019, patients with severe rheumatic mitral stenosis were prospectively recruited. Propensity score matching was performed to reduce the selection bias. We compared the strain, twist and synchrony parameters of left ventricle in 70 quinquagenarian patients who underwent rheumatic mitral valve repair and replacement 12 hours before surgery, at 7 days and 6 months postoperatively. RESULTS: The overall group displayed significant improvement of left ventricular deformation after rheumatic mitral valve surgery. Compared with patients undergoing posterior chordal-sparing mitral valve replacement, patients undergoing rheumatic mitral valve repair showed more significant amelioration in global longitudinal strain (-18.6% versus -16.2%, P<0.001), twist (18.2° versus 15.9°, P<0.001), torsion (1.8°/cm versus 1.3°/cm, P<0.001), apical rotation (10.5° versus 8.8°, P<0.001), basal rotation (-7.7° versus -7.1°, P=0.049), systolic dyssynchrony index (4.7% versus 5.1%, P=0.021), standard deviation of time to peak longitudinal (46.9 ms versus 49.3 ms, P=0.024) and radial strain (15.8 ms versus 17.1 ms, P=0.037) at 6-month follow-up. CONCLUSIONS: Rheumatic mitral valve repair might provide patients with better postoperative left ventricular performance than posterior chordal-sparing mitral valve replacement. Longer follow-up is required to compare long-term outcomes.
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Chang et al. (2020) conducted a cohort in severe rheumatic mitral stenosis (n=70). Rheumatic mitral valve repair vs. Posterior chordal-sparing mitral valve replacement was evaluated on Global longitudinal strain at 6 months (p=<0.001). Rheumatic mitral valve repair significantly improved global longitudinal strain compared to posterior chordal-sparing replacement (-18.6% vs -16.2%, P<0.001) at 6 months.
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