| Abstract: |
SUMMARY AND CONCLUSIONSThis is study includes 60 patients who have undergone mitral valve surgery (Repair=24 patients and replacement = 36 patients) for rheumatic mitral valve insufficiency during the period from marsh 2002 to April 2004 at the Cardiothoracic Department, Zagazig University Hospitals.In this study, both techniques of repair and replacement are compared as regards patient’s population, feasibility of valve repair according to the operative pathology, early and late mortality associated with each technique, early and late morbidity, effect of each procedure on left ventricular function, and left atrial size.The mean age of the patients was 26.8± 9.1 years (range = 15–55 years), 43 patients were females (80%) and 17 patients (20%) were males.The etiology of mitral valve incompetence was rheumatic heart disease.More than 87 % of patients in the repair group were in NYHA class III & IV preoperatively versus 86% in the replacement group.Postoperatively in the repair group more than 92% of patients became asymptomatic or mildly symptomatic and in the replacement group 86% of patients returned to the asymptomatic or mildly symptomatic state.There was no early or late mortality in the repair and replacement group during the follow-up period.The reoperation rate for significant mitral regurgitation was 8.2% for the repair group. In the replacement group, the reparation rate was 8.4% due to valve thrombosis, embolic complication and infective endocarditic.The incidence of thrombo-embolic complications was higher in the replacement group than in the repair group 5.6% versus zero.The rate of early postoperative or hospital morbidity was higher in the replacement group (25.2% versus 20% in the repair group).In both groups, echocardiographic evaluation showed significant improvement in the postoperative cardiac measurements and left ventricular functions compared to the preoperative findings.The cardiac measurements and left ventricular functions were statistically non significant between both groups preoperatively and there was significant statistical difference postoperatively reflecting superiority of mitral valve repair over replacement.Review of the literature was carried out and the results were discussed compared to that obtained at other centers in order to conclude possible recommendation.Our study, among the numerous studies available, confirmed the superiority of mitral valve repair over replacement in terms of early and late morbidity, mitral valve repair is associated with lower incidence of thrombo-embolic compilations compared to valve replacement better improvement of left ventricular function. However, the rate of reoperation is higher after mitral valve repair due to failure of repair but also its incidence increased after replacement due to thrombosis on the valve, thrombo-embolic complication and infective endocarditis.Preservation of the papillary muscle annual continuity is very important during mitral valve replacement where it is beneficial to left ventricular function.Although there have been no much studies directly comparing mitral valve repair to replacement, repair has shown the following advantages.Lower operative morbidity and mortality, decrease thromboembolic complication rate, potential improvement in left ventricular function reduced need for anticoagulation, lower cost, decreased frequency of late endocarditis and postoperative low cardiac output is higher after mitral valve replacement than after valve repair.Recommendation:* Rheumatic mitral regurgitation should be repaired when technically feasible accepting the risk of re-operation to maximize several and reduce morbidity.* More studies of large number of patients and follow up for long period to compare difference between both groups after long period.
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