title: Is rheumatic aetiology a predictor of poor outcome in the current era of mitral valve repair? Contemporary long-term results of mitral valve repair in rheumatic heart disease.
abstract: OBJECTIVE
  Contemporary experience with mitral valve (MV) repair in the rheumatic population is limited. We aimed to examine the long-term outcomes of rheumatic MV repair, to identify the predictors of durability and to compare the repair for rheumatic and degenerative MVs.
  
  
  METHODS
  MV repairs for both rheumatic and degenerative lesions were analysed prospectively from our valve-repair registry. The primary outcomes investigated were mortality, survival, freedom from reoperation and freedom from valve failure. Logistic and Cox regression analyses were performed to define the predictors of reoperation and valve failure.
  
  
  RESULTS
  Between 1997 and 2010, 627 consecutive rheumatic MV repairs were performed (46.7% of all mitral repair procedures). The mean age of our study group was 32 ± 19 (range 3-75 years). In-hospital mortality was 2.4% and late mortality was 0.3%. Freedoms from reoperation for rheumatics at 5 and 10 years were 91.8 ± 4.8 and 87.3 ± 3.9%, respectively, comparable with that for degenerative valves at 92.0 ± 1.7 and 91.8 ± 4.8%, respectively (P = 0.79). Freedoms from valve failure for rheumatics at 5 and 10 years were 85.6 ± 2.3 and 72.8 ± 4.6%, respectively, whereas those for degenerative repairs were 88.7 ± 5.1 and 82.4 ± 7.7%, respectively (P = 0.45). Independent predictors for reoperation and valve failure in rheumatic patients were residual mitral regurgitation >2+ and performance of commissurotomy.
  
  
  CONCLUSIONS
  The durability of MV repair for rheumatic disease in the current era has improved and is comparable with the outstanding durability of repairs for degenerative disease. Modifications of standard repair techniques, adherence to the importance of good leaflet coaptation and strict quality control with stringent use of intraoperative transoesophageal echocardiography have all contributed to the improved long-term results.
authors: Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia.
authors: Mohd Azhari
authors: MA
authors: Yakub
authors: Jeswant
authors: J
authors: Dillon
authors: Paneer S
authors: PS
authors: Krishna Moorthy
authors: Kiew Kong
authors: KK
authors: Pau
authors: Mohd Nazeri
authors: MN
authors: Nordin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D011475:Prosthesis Failure; D012086:Reoperation; D012214:Rheumatic Heart Disease / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Durability; Mitral valve repair; Predictors; Rheumatic