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Ann Thorac Surg 2007;84:451-458
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Mitral Valve Replacement Versus Repair: Propensity-Adjusted Survival and Quality-of-Life Analysis

Janne J. Jokinen, MDa, Mikko J. Hippeläinen, MD, PhDb,*, Otto A. Pitkänen, MD, PhDc, Juha E.K. Hartikainen, MD, PhDd

a Department of Cardiothoracic Surgery, Helsinki University Hospital, Helsinki, Finland
b Department of Surgery, Kuopio University Hospital, Kuopio, Finland
c Department of Anesthesiology, Kuopio University Hospital, Kuopio, Finland
d Department of Cardiology, Kuopio University Hospital, Kuopio, Finland

Accepted for publication March 20, 2007.

* Address correspondence to Dr Hippeläinen, Department of Surgery, Kuopio University Hospital, PO Box 1777, Kuopio, FIN-70211, Finland (Email: mikko.hippelainen{at}kuh.fi).

Background: We investigated whether mitral valve repair (MVP) is superior to mitral valve replacement (MVR) in terms of survival and quality of life during the long-term follow-up.

Methods: One hundred eighty-four consecutive patients underwent MVP or MVR for mitral regurgitation with or without concomitant coronary artery bypass grafting. Clinical data were recorded prospectively, and the data for the Nottingham Health Profile quality-of-life analysis was collected cross-sectionally. Propensity score analysis was used for the study group matching.

Results: The mean follow-up time was 7.3 ± 1.4 years. After adjustment for baseline characteristics by the propensity score method, there was a statistically significant survival benefit for the patients who underwent MVP (p = 0.02). Risk factors for death were preoperative unstable angina pectoris (relative risk ratio, 4.4; 95% confidence interval, 2.2 to 8.8), age older than 60 years (relative risk ratio, 1.1; 95% confidence interval, 1.0 to 1.1), use of mitral prosthesis (relative risk ratio, 2.7; 95% confidence interval, 1.4 to 5.3), preoperative renal insufficiency (relative risk ratio, 1.0; 95% confidence interval, 1.0 to 1.007), and preoperative cerebrovascular disorder (relative risk ratio, 2.7; 95% confidence interval, 1.0 to 5.3). The quality of life of the MVP and MVR groups did not differ from each other, but the MVP and the MVR patients had lower energy and mobility scores than an age- and sex-matched reference population.

Conclusions: Survival is longer after MVP than after MVR. The quality of life of MVP and MVR patients does not differ from each other. In terms of most quality-of-life variables, patients who undergo mitral valve operations cope similarly to an age- and sex-matched reference population. Only the scores reflecting energy and mobility were lower in the patients who were operated on than in the reference population.




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