Key result
In patients undergoing mitral valve repair, rheumatic etiology was associated with a 92% successful repair rate and a 93% 4-year event-free survival rate, neither of which were significantly different from outcomes in patients with degenerative etiology.
Why the study?
Does mitral valve repair yield similar clinical and echocardiographic outcomes in patients with rheumatic mitral regurgitation compared to those with degenerative mitral regurgitation?
Cohort (n=269)
No
Does mitral valve repair yield similar clinical and echocardiographic outcomes in patients with rheumatic mitral regurgitation compared to those with degenerative mitral regurgitation?
Mitral valve repair is highly feasible in selected patients with rheumatic mitral regurgitation, yielding mid-term clinical and echocardiographic outcomes comparable to those with degenerative mitral regurgitation.
Answers are grounded in this paper and cite their sources.
Supports repair feasibility in selected rheumatic MR; leaves open need for RCTs to confirm long-term equivalence.
We compared clinical (30+/-24 months) and echocardiographic follow-up (22 +/- 20 months) data of 184 consecutive patients with myxomatous degenerative mitral regurgitation (Group A) and 85 consecutive patients with rheumatic mitral regurgitation (Group B) after repair. Selection criteria for rheumatic etiology was predominant mitral regurgitation with valve area >or= 2.0 cm(2) and with no significant calcification in valvular apparatus. Repair was successful in 93% of group A and in 92% of group B (p>0.05). There was no difference of operative mortality (1% vs 0%) and of the incidence of the second-pump valve replacement (4% vs 5%). The 4-yr survival, 4-yr event-free survival, and 4-yr mitral regurgitation-free survival rates in group A were 96 +/- 2%, 89 +/- 4%, and 76 +/- 5%, respectively, which were not different from those in group B (97 +/-2 %, 93 +/- 4%, and 68 +/-7 %, p >0.05). Independent determinants of development of at least moderate regurgitation in group A were no use of ring annuloplasty (hazards ratio 6.6, 95% CI 2.0 to 21.5) and new chordae formation (hazards ratio 3.5, 95% CI 1.4 to 8.7). In group B, no use of ring annuloplasty (hazards ratio 15.3, 95% CI 3.5 to 66.7) also was independent predictor. Valve repair is highly feasible in selected patients with rheumatic mitral regurgitation, and clinical course is not significantly different from that of patients with degenerative mitral regurgitation.
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Song et al. (2003) conducted a cohort in Mitral regurgitation (n=269). Rheumatic mitral regurgitation vs. Degenerative mitral regurgitation was evaluated on Successful valve repair (p=>0.05). In patients undergoing mitral valve repair, rheumatic etiology was associated with a 92% successful repair rate and a 93% 4-year event-free survival rate, neither of which were significantly different from outcomes in patients with degenerative etiology.
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