Comparison of Repair vs Replacement in Calcific and Rheumatic Mitral Disease

Marek A Deja; Marcin Malinowski; Kazimierz Widenka; Nikodem Stożyński; Krzysztof Bartuś; Bogusław Kapelak; Mariusz Kuśmierczyk; Grzegorz Hirnle; Piotr Suwalski; Marek Jasiński; Witold Gerber; Zdzisław Tobota; Kamil Barański; Bohdan J Maruszewski

doi:10.1016/j.athoracsur.2023.04.048

Comparison of Repair vs Replacement in Calcific and Rheumatic Mitral Disease

Ann Thorac Surg. 2023 Nov;116(5):954-961. doi: 10.1016/j.athoracsur.2023.04.048. Epub 2023 Jun 3.

Affiliations

¹ Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland. Electronic address: mdeja@sum.edu.pl.
² Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland.
³ Department of Cardiac Surgery, University of Rzeszów, Rzeszów, Poland.
⁴ Department of Cardiac Surgery, District Hospital No 2, Rzeszów, Poland.
⁵ Department of Surgery of Heart, Vessels and Transplantology, Jagiellonian University Medical College, Kraków, Poland.
⁶ Department of Cardiac Surgery, Warsaw Medical University, Warszawa, Poland.
⁷ Department of Cardiac Surgery, Transplantology, Vascular and Endovascular Surgery, Silesian Centre for Heart Disease, Zabrze, Poland.
⁸ Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Warszawa, Poland.
⁹ Department of Cardiac Surgery, Wroclaw Medical University, Wrocław, Poland.
¹⁰ Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland.
¹¹ Department of Cardiac Surgery, Children's Memorial Health Institute, Warszawa, Poland.
¹² Department of Epidemiology, Medical University of Silesia, Katowice, Poland.

PMID: 37271445
DOI: 10.1016/j.athoracsur.2023.04.048

Abstract

Background: The benefit of repair over replacement of rheumatic or calcified mitral valve (MV) is debatable.

Methods: Patients who underwent MV repair or replacement for rheumatic or calcified MV disease between 2006 and 2020 were identified in the Polish National Registry of Cardiac Surgery Procedures. Patients who underwent additional procedures other than coronary artery bypass grafting or tricuspid valve surgery, as well as redo or emergency cases, were excluded. The long-term survival was verified based on National Health Fund registry data. The survival was compared between MV repair and replacement in the whole cohort and after propensity score matching.

Results: We included 4338 patients: 1859 (43%) with pure mitral regurgitation and 2479 (57%) with mitral stenosis. MV was repaired in 543 patients (29%) with pure regurgitation and 126 (5.1%) with stenosis (P < .001). In total, 984 (23%) patients underwent concomitant coronary artery bypass grafting and 1358 (32%) tricuspid valve surgery. MV repair improved survival (hazard ratio 0.81; 95% CI 0.68-0.97; P = .022) in patients with no mitral stenosis, and had no effect in mitral stenosis (hazard ratio 1.17; 95% CI 0.85-1.59; P = .332). The results were confirmed in propensity-matched cohorts. The freedom from MV reoperation at 10 years was 95.5% ± 1.2% after repair and 96.0% ± 0.7% after MV replacement (P = .416) in the absence of stenosis and 91.8% ± 3.4% after repair vs 95.9% ± 0.5% after replacement in patients with mitral stenosis (P = .065).

Conclusions: Repair of rheumatic/calcified mitral valve should be a preferred option in patients with no mitral stenosis, but confers no benefit if mitral stenosis is present.