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Ann Thorac Surg 2009;87:1735-1740. doi:10.1016/j.athoracsur.2009.03.009
© 2009 The Society of Thoracic Surgeons
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Bachar El Oumeiri
Munir Boodhwani
David Glineur
Laurent De Kerchove
Alain Poncelet
Parla Astarci
Robert Verhelst
Gébrine El Khoury
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Right arrow Valve disease

Original Articles: Adult Cardiac

Extending the Scope of Mitral Valve Repair in Rheumatic Disease

Bachar El Oumeiri, MD*, Munir Boodhwani, MD, MMSc, David Glineur, MD, Laurent De Kerchove, MD, Alain Poncelet, MD, Parla Astarci, MD, Agnes Pasquet, MD, Jean-Louis Vanoverschelde, MD, PhD, Robert Verhelst, MD, Jean Rubay, MD, PhD, Philipe Noirhomme, MD, Gébrine El Khoury, MD

Department of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium

Accepted for publication March 6, 2009.

* Address correspondence to Dr El Oumeiri, Service de Chirurgie Cardiovasculaire et Thoracique, Cliniques Universitaires, Saint-Luc UCL 90, Avenue Hippocrate 10, Brussels, B-1200, Belgium (Email: beloumei{at}ulb.ac.be).

Background: Repair of rheumatic mitral valves has met with limited success because hemodynamic obstruction may persist after repair because of residual diseased leaflet tissue and lack of suppleness. Over the past decade, we have developed and implemented an aggressive approach to rheumatic mitral valve repair with radical excision of the diseased leaflets area, and subvalvular apparatus and subsequent reconstruction, with the objective of removing all diseased valvular tissue.

Methods: From July 1996 to June 2007, 78 patients underwent mitral valve repair for rheumatic valve disease. Over the same time interval, 54 patients underwent mitral valve replacement. Mean age was 56.4 ± 16 years. Clinical follow-up (mean 60 ± 36 months) was complete in 100% of patients, and echocardiographic follow-up (mean 52 ± 37 months) was 96% complete.

Results: There was no hospital mortality or early reoperations. Overall survival was 94% ± 6% at 8 years, and 95% of patients were in New York Heart Association functional class II or less. Three patients (4%) required reoperation for mitral restenosis and 2 underwent re-repair. At 8 years of follow-up, freedom from cardiac death and mitral valve reoperation were 98% ± 2% and 94% ± 5%, respectively. Freedom from valve-related events at 5 and 10 years was 90% ± 8% and 86% ± 11%, and freedom from significant mitral regurgitation was 98% ± 2% at 5 years and 83% ± 9% at 8 years.

Conclusions: A more aggressive approach to resection of diseased valvular tissue with subsequent reconstruction is feasible, with good midterm results, and may extend the scope of valve repair in rheumatic disease patients.






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