title: Echocardiographic evaluation of mitral durability following valve repair in rheumatic mitral valve disease: impact of Maze procedure.
abstract: OBJECTIVE
  The data on echocardiographic evaluation of mitral durability after rheumatic mitral repair is scarce.
  
  
  METHODS
  A total of 193 patients (mean age, 39.4 ± 12.8 years; 154 females) who underwent mitral valve repair for rheumatic valve disease from 1997 to 2010 were included in the study. A Maze operation was performed in 90.3% (n = 102) of the patients with atrial fibrillation (n = 113). Survival, valve-related complications, and echocardiographic data were evaluated.
  
  
  RESULTS
  Mitral regurgitation was the predominant disease in 75.6% of patients (n = 146). There was one early death (0.5%) . During the mean follow-up period of 76.7 ± 45.6 months, there were 9 late deaths and 5 mitral reoperations. Valve-related, event-free survival at 10 years was 85.5% ± 3.3%. In serial postoperative echocardiographic evaluations (mean follow-up duration, 53.7 ± 43.5 months), 40 patients showed either mitral regurgitation (>mild; n = 31) or mitral stenosis (mitral valve area ≤1.5 cm(2); n = 9). At 10 years, 66.4% ± 5.4% of the patients did not have moderate to severe mitral dysfunction. By multivariate analysis, no Maze operation for atrial fibrillation was an independent predictor of mitral dysfunctions (hazard ratio, 3.72; 95% confidence interval, 1.47-9.42; P = .005), whereas the presence of hypertension had borderline significance (hazard ratio, 3.15; 95% confidence interval, 0.96-10.38; P = .059).
  
  
  CONCLUSIONS
  Although rheumatic mitral repair showed excellent long-term clinical outcomes, a significant proportion of patients experienced moderate to severe mitral dysfunctions postoperatively. Atrial fibrillation without a Maze procedure increased significantly the risks of mitral dysfunctions and adverse outcomes. Therefore, routine performance of a Maze procedure is warranted in the presence of atrial fibrillation whenever possible.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Gwan Sic
authors.initials: GS
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Chee Hoon
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Joon Bum
authors.initials: JB
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Sung-Ho
authors.initials: SH
authors.lastname: Jung
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Suk Jung
authors.initials: SJ
authors.lastname: Choo
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Cheol Hyun
authors.initials: CH
authors.lastname: Chung
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: jwlee@amc.seoul.kr.
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Lee
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects / Q000401:mortality; D000328:Adult; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D015150:Echocardiography, Doppler; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome