title: Comparative long-term results of mitral valve repair in adults with chronic rheumatic disease and degenerative disease: is repair for "burnt-out" rheumatic disease still inferior to repair for degenerative disease in the current era?
abstract: OBJECTIVE
  Mitral valve repair is perceived to be of limited durability for advanced rheumatic disease in adults. We aim to examine the long-term outcomes of repair for rheumatic disease, identify predictors of durability, and compare with repair for degenerative disease.
  
  
  METHODS
  Rheumatic and degenerative mitral valve repairs in patients aged 40 years or more were prospectively analyzed. The primary outcomes investigated were mortality, freedom from reoperation, and valve failure. Logistic regression analysis was performed to define predictors of poor outcome.
  
  
  RESULTS
  Between 1997 and 2011, 253 rheumatic and 148 degenerative mitral valves were repaired. The age of patients in both groups was similar, with a mean of 54.1 ± 8.4 years versus 55.6 ± 7.3 years (P = .49). Freedom from reoperation for rheumatic valves at 5 and 10 years was 98.4%, comparable to 95.3% (P = .12) for degenerative valves. Freedom from valve failure at 5 and 10 years was 91.4% and 81.5% for rheumatic repairs and 82.5% and 75.4% for degenerative repairs, respectively (P = .15). The presence of residual mitral regurgitation greater than 2+ before discharge was the only significant independent predictor of reoperation, whereas residual mitral regurgitation greater than 2+ and leaflet procedures were significant risk factors for valve failure.
  
  
  CONCLUSIONS
  The durability of rheumatic mitral valve repair in the current era has improved and is comparable to the outstanding durability of repairs for degenerative disease, even in the adult rheumatic population. Modifications of standard repair techniques, adherence to the importance of good leaflet coaptation, and strict quality control with stringent use of intraoperative transesophageal echocardiography have all contributed to the improved long-term results.
authors.affiliation: Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia. Electronic address: jeswant@ijn.com.my.
authors.forename: Jeswant
authors.initials: J
authors.lastname: Dillon
authors.affiliation: Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Mohd Azhari
authors.initials: MA
authors.lastname: Yakub
authors.affiliation: Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Pau Kiew
authors.initials: PK
authors.lastname: Kong
authors.affiliation: Clinical Research Department, National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Mohd Faizal
authors.initials: MF
authors.lastname: Ramli
authors.affiliation: Clinical Research Department, National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Norfazlina
authors.initials: N
authors.lastname: Jaffar
authors.affiliation: Clinical Research Department, National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Intan Fariza
authors.initials: IF
authors.lastname: Gaffar
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012086:Reoperation; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography