Outcomes of Mitral Valve Repair Compared with Replacement for Patients with Rheumatic Heart Disease

Abstract Objective Whether mitral valve repair is superior to replacement in rheumatic population has been debated, this study aims to compare outcomes of repair with replacement by propensity score method. Methods This observational prospective study enrolled patients with rheumatic heart disease who underwent mitral valve repair and replacement from January 2011 to April 2019. The propensity score method was utilized to select 2 groups with similar baseline characteristics. Baseline, clinical, and follow-up data were collected. Clinical outcomes included death from any cause, reoperation, and valve-related complications. Results The overall population before matching (N=1644) included 612 patients who underwent repair and 1032 patient who underwent replacement. The propensity score analysis generated matches for a total of 1058 patients (529 pairs). The median follow-up time was 4.12 years. Early mortality and death from any cause during follow-up were significantly lower in the repair group compared to the replacement group (hazards ratio (HR): 0.19, 95% CI: 0.05-0.64, P =0.003; HR: 0.38, 95% CI: 0.19-0.74, P =0.003, respectively). Patients in the repair group had a lower risk of valve-related complications compared with patients in the replacement group (subhazard ratio(SHR): 0.44, 95% CI: 0.21-0.90, P=0.025). In terms of reoperation, no significant difference was observed between the repair and replacement groups (SHR: 2.54, 95% CI: 0.89-7.22, P=0.081). Conclusions The results suggest that rheumatic mitral valve repair in proper patients is superior to mitral valve replacement with regard to lower mortality and fewer valve-related complications, meanwhile, it has comparable risk of reoperation compared with replacement.