Valve characteristics and surgical options for severe rheumatic mitral stenosis with more than mild regurgitation: A dual-center retrospective study.

Abstract

The optimal surgical strategy for severe rheumatic mitral stenosis with more than mild mitral regurgitation (MR) remains unclear. We aimed to characterize mitral valve pathology in these patients and compare outcomes between valve repair and valve replacement. This dual-center retrospective study analyzed 870 surgically treated severe rheumatic mitral stenosis patients with complete imaging. Inverse probability weighting balanced baseline characteristics (standardized mean difference <0.1). Quantitative assessment combined echocardiography and computed tomography angiography. The primary endpoint was all-cause mortality. Among the 870 patients, 408 (46.9%) had greater than mild MR. Compared to patients with pure stenosis, these patients had larger left atrial diameters (51.0 mm vs 49.0 mm; P < .001), higher mean pulmonary artery pressures (42.0 mm Hg vs 41.0 mm Hg; P = .015), shorter anterior (33.3 mm vs 33.7 mm; P = .026) and posterior (19.2 mm vs 20.0 mm; P < .001) leaflets, and a comparable rate of mitral valve repair (65.0% vs 63.0%; P = .595). Among patients with more than mild MR, early outcomes did not differ between repair (n = 265) and replacement (n = 143). At 5-year postoperative follow-up, repair was associated with significantly lower mortality (1.4% vs 7.1%; P = .009) and a comparable reoperation rate (1.4% vs 1.0%; P = 1.000). Survival analysis favored repair (log-rank P = .005), which independently predicted survival (hazard ratio, 0.347; P = .039). Nearly one-half of severe rheumatic mitral stenosis patients present with more than mild MR. Mitral repair demonstrates improved 5-year survival without an increased risk of reoperation, supporting its consideration as a key candidate strategy when feasible.