Mitral valve repair is durable in patients with rheumatoid arthritis

John M. Stulak, Rakesh M. Suri, Eric Lawrence Matteson, Joseph A. Dearani, Heidi M. Connolly, Hartzell V Schaff

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)510-515
Number of pages6
JournalAnnals of Thoracic Surgery
Volume94
Issue number2
DOIs
StatePublished - Aug 2012

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Mitral Valve
Rheumatoid Arthritis
Mitral Valve Insufficiency
Survival
Prolapse
Reoperation
Arthritis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Mitral valve repair is durable in patients with rheumatoid arthritis. / Stulak, John M.; Suri, Rakesh M.; Matteson, Eric Lawrence; Dearani, Joseph A.; Connolly, Heidi M.; Schaff, Hartzell V.

In: Annals of Thoracic Surgery, Vol. 94, No. 2, 08.2012, p. 510-515.

Research output: Contribution to journalArticle

Stulak, John M. ; Suri, Rakesh M. ; Matteson, Eric Lawrence ; Dearani, Joseph A. ; Connolly, Heidi M. ; Schaff, Hartzell V. / Mitral valve repair is durable in patients with rheumatoid arthritis. In: Annals of Thoracic Surgery. 2012 ; Vol. 94, No. 2. pp. 510-515.
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abstract = "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.",
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