title: Rheumatic mitral valve surgery in the fifth decade: our experience.
abstract: OBJECTIVE
  Rheumatic mitral patients reach their fifth decade of life more often now than in the past. The purpose of this study is to provide insight into improving morbidity and mortality in these patients.
  
  
  METHODS
  This retrospective study included 105 patients aged 50 years or more. Seventy-five underwent mechanical valve replacement and 30 received a bioprosthetic valve. Data were collected from medical records and outpatient department (OPD) registers. Follow-up included transthoracic 2D echocardiography, supported by clinical parameters, and X-ray findings.
  
  
  RESULTS
  Mean age was 58.52+/-2.4 years. Follow-up period ranged from one to eleven years (mean 6.8+/-0.9 years). Immediate perioperative mortality included five patients (4.76%) and long term mortality included three patients (3%). 35 patients previously underwent closed and open commissurotomy and balloon valvotomy. Multivariate analysis showed age, repeat surgery, atrial fibrillation, tricuspid valve disease, and preoperative functional status to be incremental risk factors. Freedom from repeat operation at 3 and 6 years was 90% and 85% in group I (<60 years), respectively. Actuarial survival at 4 and 6 years of follow up was 94.24% and 88.52%, respectively.
  
  
  CONCLUSIONS
  With improving life expectancy and early interventions, the number of < or = 50-year old rheumatic valvular disease patients is increasing. The present study showed a marked improvement for this subset of patients, although age still remains the main risk factor along with atrial fibrillation, repeat surgery, stroke and tricuspid valve disease.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Lokmanya Tilak Medical College and Hospital, Sion, Mumbai, India. kaushalendra_rathore @hotmail.com
authors.forename: K S
authors.initials: KS
authors.lastname: Rathore
authors.forename: P
authors.initials: P
authors.lastname: Kumar
authors.forename: U
authors.initials: U
authors.lastname: Jadhav
authors.forename: A G
authors.initials: AG
authors.lastname: Tendolkar
mesh_terms: D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000401:mortality; D001705:Bioprosthesis; D002303:Cardiac Output, Low / Q000209:etiology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery*; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000473:pathology