title: Late outcomes of mitral repair in rheumatic patients.
abstract: OBJECTIVE
  The long-term results after surgical repair of rheumatic mitral valve remain controversial in literature. Our aim was to determine the predictive factors which impact the long-term results after isolated rheumatic mitral valve repair and to evaluate the effect of those factors on reoperation and late mortality.
  
  
  METHODS
  One hundred and four patients with rheumatic valve disease who had undergone mitral valve repair with or without tricuspid valve annuloplasty were included. All patients with associated procedures were excluded. The predictive variables for reoperation were assessed with Cox regression and Kaplan Meier survival curves.
  
  
  RESULTS
  The mean follow-up time was 63 ± 39 months (CI 95% 36 to 74 months). The functional class III and IV was observed in 65.4% of all patients. The posterior ring annuloplasty was performed in 33 cases, comissutoromy in 21 cases, and comissurotomy with posterior ring annuloplasty in 50 patients. There was no operative mortality. The late mortality was 2.8% (three patients). The late reoperation was associated with residual mitral valve regurgitation after surgery (P<0.001), pulmonary hypertension at the pre-operative time (P<0.001), age (P<0.04) and functional class at the post-operative time (P<0.001). We observed freedom from reoperation rates at 5 and 10 years of 91.2 ± 3.4% and 71.1 ± 9.2%, respectively.
  
  
  CONCLUSIONS
  Repair of mitral valve in rheumatic valve disease is feasible with good long-term outcomes. Preoperative pulmonary hypertension, residual mitral valve regurgitation after surgery, age and functional class are predictors of late reoperation.
authors.affiliation: Discipline of Cardiac Surgery at State University of Campinas (Unicamp), Campinas, SP, Brazil.
authors.forename: Elaine Soraya Barbosa de Oliveira
authors.initials: ES
authors.lastname: Severino
authors.forename: Orlando
authors.initials: O
authors.lastname: Petrucci
authors.forename: Karlos Alexandre de Souza
authors.initials: KA
authors.lastname: Vilarinho
authors.forename: Carlos Fernando Ramos
authors.initials: CF
authors.lastname: Lavagnoli
authors.forename: Lindemberg da Mota
authors.initials: Lda M
authors.lastname: Silveira Filho
authors.forename: Pedro Paulo Martins de
authors.initials: PP
authors.lastname: Oliveira
authors.forename: Reinaldo Wilson
authors.initials: RW
authors.lastname: Vieira
authors.forename: Domingo Marcolino
authors.initials: DM
authors.lastname: Braile
mesh_terms: D004812:Epidemiologic Methods; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality* / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000150:complications*; D011300:Preoperative Care; D012086:Reoperation / Q000706:statistics & numerical data; D012214:Rheumatic Heart Disease / Q000401:mortality* / Q000601:surgery; D012307:Risk Factors; D016896:Treatment Outcome