Is Rheumatic Mitral Valve Disease Still Maintaining its Prevalence in Our Country? Early and Long-term Outcomes After Mitral Valve Replacement with Rheumatic Origin
Mehmet Erin Tüysüz, Mehmet Dedemoğlu
Keywords: Acute rheumatic fever, atrial fibrillation, mitral valve replacement, rheumatic mitral valve disease
Introduction: The purpose of this study was to present early and long-term results of mitral valve replacement in the treatment of rheumatic mitral valve disease, encountered frequently as an etiology in our clinic. Patients and Methods: All patients undergoing mitral valve replacement in our clinic between July 2008 and December 2017 were retrospectively reviewed. Patients with rheumatic mitral stenosis and/or regurgitation were included in the study. Primary outcome of interest was early mortality rates, long-term survival rates, and independent predictors of long-term survival. Results: In total, 88 patients were included in the study. Early mortality was observed in 4 (4.5%) patients. Concomitant arrhythmia surgery was performed in 19 (21.6%) patients with preoperative atrial fibrillation, and 11 of the 19 (12.5%) patients showed sinus rhythm after the operation. Overall 5-year survival rate was 77.9%. When compared to the valve pathologies, 5-year survival rates was 72.6% in patient group with isolated mitral stenosis, 81.8% in patient group with isolated mitral regurgitation, and 86.7%, in patient group with combined mitral stenosis and regurgitation. There was no statistically significant difference among the groups (p= 0.63). The existence of preoperative chronic renal failure (HR, 33.4; 95% CI, 4.1-272.3; p= 0.001) and cardiopulmonary bypass time (HR, 1.05; 95% CI, 1.02-1.08; p< 0.001) were independent predictors of long-term survival. Conclusion: Rheumatic mitral valve disease remains a problem in our country due to rural and border migration. Valve replacement is an optimal choice and produces satisfactory results in terms of prevention of recurrence and provision of effective valve orifice area. In addition, it is necessary to take precautions in the presence of preoperative chronic renal failure and to avoid prolonged cardiopulmonary bypass periods during the operation to ensure long term survival.