title: Extending the scope of mitral valve repair in rheumatic disease.
abstract: BACKGROUND
  Repair of rheumatic mitral valves has met with limited success because hemodynamic obstruction may persist after repair because of residual diseased leaflet tissue and lack of suppleness. Over the past decade, we have developed and implemented an aggressive approach to rheumatic mitral valve repair with radical excision of the diseased leaflets area, and subvalvular apparatus and subsequent reconstruction, with the objective of removing all diseased valvular tissue.
  
  
  METHODS
  From July 1996 to June 2007, 78 patients underwent mitral valve repair for rheumatic valve disease. Over the same time interval, 54 patients underwent mitral valve replacement. Mean age was 56.4 +/- 16 years. Clinical follow-up (mean 60 +/- 36 months) was complete in 100% of patients, and echocardiographic follow-up (mean 52 +/- 37 months) was 96% complete.
  
  
  RESULTS
  There was no hospital mortality or early reoperations. Overall survival was 94% +/- 6% at 8 years, and 95% of patients were in New York Heart Association functional class II or less. Three patients (4%) required reoperation for mitral restenosis and 2 underwent re-repair. At 8 years of follow-up, freedom from cardiac death and mitral valve reoperation were 98% +/- 2% and 94% +/- 5%, respectively. Freedom from valve-related events at 5 and 10 years was 90% +/- 8% and 86% +/- 11%, and freedom from significant mitral regurgitation was 98% +/- 2% at 5 years and 83% +/- 9% at 8 years.
  
  
  CONCLUSIONS
  A more aggressive approach to resection of diseased valvular tissue with subsequent reconstruction is feasible, with good midterm results, and may extend the scope of valve repair in rheumatic disease patients.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium. beloumei@ulb.ac.be
authors.forename: Bachar
authors.initials: B
authors.lastname: El Oumeiri
authors.forename: Munir
authors.initials: M
authors.lastname: Boodhwani
authors.forename: David
authors.initials: D
authors.lastname: Glineur
authors.forename: Laurent
authors.initials: L
authors.lastname: De Kerchove
authors.forename: Alain
authors.initials: A
authors.lastname: Poncelet
authors.forename: Parla
authors.initials: P
authors.lastname: Astarci
authors.forename: Agnes
authors.initials: A
authors.lastname: Pasquet
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vanoverschelde
authors.forename: Robert
authors.initials: R
authors.lastname: Verhelst
authors.forename: Jean
authors.initials: J
authors.lastname: Rubay
authors.forename: Philipe
authors.initials: P
authors.lastname: Noirhomme
authors.forename: Gébrine
authors.initials: G
authors.lastname: El Khoury
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006349:Heart Valve Diseases / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome