Keeping the mitral smile: is it durable? A comparative study of mid-term outcomes of mitral valve repair and mechanical mitral valve replacement in rheumatic heart patients

Comparative Study of Mid-Term Outcomes of Mitral Valve Repair and Mechanical Mitral Valve Replacement in Rheumatic Heart Patients

Abstract

Background: Rheumatic heart disease is a significant cause of morbidity and mortality in endemic countries. Traditionally, mechanical valve replacement has been the preferred surgical approach for treating rheumatic mitral valve disease due to its favorable short-term outcomes and low incidence of postoperative complications. However, its midterm results are suboptimal due to increased risks of thrombosis and bleeding. This study compared the midterm outcomes of mitral valve surgeries, repair versus replacement, in rheumatic patients.

Methods: A comparative retrospective clinical study was conducted from January 2016 to December 2018. The study included 203 patients who underwent mitral valve surgery for rheumatic heart disease. The patients were divided into two groups: Group A (n=107) had mitral valve repair, and Group B (n=96) had mitral valve replacement.

Results: In Group A, the mean age was 45.5 ± 5.2 years, and 49% of the patients were male. While in Group B, the mean age was 46.2 ± 5.35 years, and 54.75% of the patients were males. The two groups had no significant difference regarding cardiac dimensions or function preoperatively. In Group A, the mean cardiopulmonary bypass time was 89 ± 9 minutes, and the mean cross-clamp time was 81 ± 7 minutes; in Group B, the mean cardiopulmonary bypass time was 77±12 min, and the mean cross-clamp time was 81 ± 7 min. The two groups had highly significant differences concerning cardiopulmonary bypass and cross-clamp times (p<0.001). Survival at 5 years was 98.5% for Group A vs. 93.15% for Group B (0.09). The reoperation rate was 9.0% in Group A vs. 4% in Group B (p= 0.261). The thromboembolism incidence was 0.47% in Group A vs. 7.3% in Group B (p= 0.03), and the bleeding-related complications were 0.94% in Group A vs. 7.3% in Group B (p= 0.03).

Conclusion: The outcomes of mitral valve repair could be comparable to replacement in patients with rheumatic heart disease. Mitral valve replacement were associated with higher bleeding and thromboembolic complications compared to mitral valve repair.