Rheumatic mitral valve repair or replacement in the valve-in-valve era

Commentary: To replace or not to replace? The big question and how to find the answer

“…This new approach altered the operative decision-making process, leading to a lower threshold for replacement when the AL was rigid or calcified (70% repair rate in era 1 vs 33% in era 2). 1 This process was successful, as the operative era 1 was the strongest independent predictor of the primary outcome. These results are very important and confirm a very recent propensity-matched report that supports the evidence that RMV repair in selected patients is superior to mitral valve replacement.…”

“…In the latest issue of the Journal, Brescia and colleagues 1 have approached a delicate subject: replace or repair a rheumatic mitral valve (RMV)? For degenerative mitral valve disease, there is large evidence and overall consensus on the fact that valve repair is better than replacement.…”

“…Starting from this background, the authors have retrospectively analyzed their data on RMV comparing 2 different eras with a primary composite outcome of death, reoperation, and severe valve dysfunction. 1 Their hypothesis is that a change in approach of the anterior leaflet (AL) had a significant impact on the results: indeed, around 2009 their surgical approach to RMV changed and included a systematic echocardiographic and intraoperative assessment specifically dedicated to the AL. This new approach altered the operative decision-making process, leading to a lower threshold for replacement when the AL was rigid or calcified (70% repair rate in era 1 vs 33% in era 2).…”

“…These results are very important and confirm a very recent propensity-matched report that supports the evidence that RMV repair in selected patients is superior to mitral valve replacement. 2 The study from Brescia and colleagues, 1 although not representing the largest series of RMV, clearly defines an effective method of planning the surgical strategy that is not influenced by the presence and degree of mitral valve regurgitation alone. Similar to previous articles, 3 there was no significant difference in mortality between mitral valve repair group and replacement group, although it has to be acknowledged that vast majority of the reoperations were related to repairs.…”

Commentary: Rheumatic mitral repair: Just don't do it?

“…Commentary: Rheumatic mitral repair: Just don't do it? Patrick M. McCarthy, MD Fortunately, rheumatic disease has greatly decreased in the United States and as noted by Brescia and colleagues 1 is different here than much of Asia with a preponderance of mitral stenosis (MS) or mixed disease. Of note, it generally occurs later in life as well, and the mean age in this report was 59 AE 14 years.…”