Echocardiographic evaluation of mitral durability following valve repair in rheumatic mitral valve disease: impact of Maze procedure

J Thorac Cardiovasc Surg. 2014 Jan;147(1):247-53. doi: 10.1016/j.jtcvs.2012.10.007. Epub 2012 Nov 21.

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.

Keywords: 24; 35; AF; CI; HR; MV; atrial fibrillation; confidence interval; hazard ratio; mitral valve.

MeSH terms

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