Long-term outcomes of rheumatic mitral valve repair: Is it worthwhile to do it?

Aim This retrospective study was undertaken to evaluate the long-term outcomes of mitral valve repair in rheumatic patients. Methods From 2003 to 2019, 151 patients (mean age 26.5 +/- 14.9 years; 68.9% female) underwent mitral valve repair. Fifty-three (35.1%) had atrial fibrillation, and 79 (52.3%) were in New York Heart Association class III/IV. Pure mitral regurgitation was present in 109 (72.2%) patients, pure stenosis in 9 (6%), and mixed regurgitation and stenosis in 33. Results Three (2%) patients died postoperatively and 4 (2.6%) were lost during follow-up. Mean follow-up was 90.5 +/- 55.6 months. There were 22 (14.8%) late deaths. Actuarial survival at 5, 10, and 15 years was 90.7% +/- 2.5%, 83.5% +/- 3.6%, and 76.5 +/- 6.1%, respectively. Twelve (8.5%) patients underwent reoperation. Freedom from reoperation at 5, 10, and 15 years was 96.1% +/- 1.7%, 89.8% +/- 3.2%, and 82.3% +/- 6.1%, respectively. Forty-two (29.2%) patients developed recurrent mitral regurgitation. Freedom from recurrence of mitral regurgitation at 5, 10, and 15 years was 70.9% +/- 4.3%, 56% +/- 5.9%, and 53.3% +/- 6.4%, respectively. Eighty-one (56.6%) patients were and free from all events during follow-up. Freedom from all events at 5, 10, and 15 years was 64.8% +/- 4.1%, 48.6% +/- 5.3%, and 43.7% +/- 5.8%, respectively. Conclusions Although rheumatic mitral valve repair is associated with late recurrence of mitral regurgitation, it has benefits in selected patients, especially children and young patients who want to avoid the lifelong risks of anticoagulation. Long-term follow-up is essential in these patients.