TY - JOUR
T1 - Mitral valve repair is durable in patients with rheumatoid arthritis
AU - Stulak, John M.
AU - Suri, Rakesh M.
AU - Matteson, Eric L.
AU - Dearani, Joseph A.
AU - Connolly, Heidi M.
AU - Schaff, Hartzell V.
PY - 2012/8
Y1 - 2012/8
N2 - Background: Rheumatoid arthritis (RA) and its treatments are associated with tissue abnormalities, which may influence surgical outcomes of repair for severe mitral valve regurgitation (MR). We examined late survival and durability of mitral valve repair in patients with RA. Methods: Thirty-six patients with RA (21 male) underwent mitral valve repair for MR from August 1978 to August 2005. Median age was 70 years (range, 22 to 84). Preoperatively, 27 patients (75%) had New York Heart Association Functional Class III/IV symptoms, and 29 (78%) required immunomodulating medications for RA management. Mechanisms of MR were leaflet prolapse in 26 patients (72%), leaflet malcoaptation in 5 (14%), tethering in 4 (11%), and unknown in 1 (3%). Results: All patients underwent mitral valve repair, which included posterior leaflet triangular resection in 11 patients, leaflet plication in 10, and artificial chordae placement in 3. When compared with matched control patients without RA who underwent mitral valve repair, RA patients had decreased survival (27% versus 64%, p = 0.005) and freedom from reoperation (93% versus 98%, p = 0.04) at 8 years. However, RA patients undergoing mitral valve repair had similar survival at 5 years compared with age- and sex-matched comparator patients with RA who did not undergo mitral valve surgery (65% versus 67%, p = nonsignificant). Conclusions: Mitral leaflet pathology in RA patients with severe MR is similar to that of non-RA patients with mitral valve disease. Long-term survival after mitral valve repair in RA patients is equivalent to that of the general RA population without mitral valve disease, and the durability of mitral valve repair in these patients is very good.
AB - Background: Rheumatoid arthritis (RA) and its treatments are associated with tissue abnormalities, which may influence surgical outcomes of repair for severe mitral valve regurgitation (MR). We examined late survival and durability of mitral valve repair in patients with RA. Methods: Thirty-six patients with RA (21 male) underwent mitral valve repair for MR from August 1978 to August 2005. Median age was 70 years (range, 22 to 84). Preoperatively, 27 patients (75%) had New York Heart Association Functional Class III/IV symptoms, and 29 (78%) required immunomodulating medications for RA management. Mechanisms of MR were leaflet prolapse in 26 patients (72%), leaflet malcoaptation in 5 (14%), tethering in 4 (11%), and unknown in 1 (3%). Results: All patients underwent mitral valve repair, which included posterior leaflet triangular resection in 11 patients, leaflet plication in 10, and artificial chordae placement in 3. When compared with matched control patients without RA who underwent mitral valve repair, RA patients had decreased survival (27% versus 64%, p = 0.005) and freedom from reoperation (93% versus 98%, p = 0.04) at 8 years. However, RA patients undergoing mitral valve repair had similar survival at 5 years compared with age- and sex-matched comparator patients with RA who did not undergo mitral valve surgery (65% versus 67%, p = nonsignificant). Conclusions: Mitral leaflet pathology in RA patients with severe MR is similar to that of non-RA patients with mitral valve disease. Long-term survival after mitral valve repair in RA patients is equivalent to that of the general RA population without mitral valve disease, and the durability of mitral valve repair in these patients is very good.
UR - http://www.scopus.com/inward/record.url?scp=84864276222&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84864276222&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2012.03.028
DO - 10.1016/j.athoracsur.2012.03.028
M3 - Article
C2 - 22607783
AN - SCOPUS:84864276222
SN - 0003-4975
VL - 94
SP - 510
EP - 515
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 2
ER -