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: Gwan Sic Kim, Chee Hoon Lee, Joon Bum Kim, Sung-Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won Lee
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 147 Issue 1 Pg. 247-53 (Jan 2014) ISSN: 1097-685X [Electronic] United States
• PMID: 23177125 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Topics

• Ablation Techniques (adverse effects, mortality)
• Adult
• Atrial Fibrillation (diagnosis, mortality, surgery)
• Disease-Free Survival
• Echocardiography, Doppler
• Female
• Heart Valve Prosthesis Implantation (adverse effects, mortality)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Mitral Valve (diagnostic imaging, surgery)
• Mitral Valve Annuloplasty (adverse effects, mortality)
• Mitral Valve Insufficiency (diagnostic imaging, mortality, surgery)
• Mitral Valve Stenosis (diagnostic imaging, mortality, surgery)
• Multivariate Analysis
• Postoperative Complications (mortality, surgery)
• Predictive Value of Tests
• Proportional Hazards Models
• Reoperation
• Retrospective Studies
• Rheumatic Heart Disease (diagnostic imaging, mortality, surgery)
• Risk Factors
• Time Factors
• Treatment Outcome