Mitral valve repair versus bioprosthetic replacement outcomes in patients with rheumatic disease over 60: Propensity score-matching results.

BACKGROUND: Rheumatic mitral valve disease remains a significant health issue in developing countries, especially among elderly patients with severe valvular abnormalities. The optimal surgical intervention-mitral valve repair versus bioprosthetic mitral valve replacement-for patients aged more than 60 years is debated because of limited studies in this age group. We aimed to compare mid- to long-term outcomes of mitral valve repair and bioprosthetic mitral valve replacement in elderly patients with rheumatic mitral valve disease.

METHODS: We retrospectively analyzed patients aged 60 years or more who underwent mitral valve repair or bioprosthetic mitral valve replacement at Anzhen Hospital from January 2011 to June 2023. Propensity score matching was used to balance the groups. Kaplan-Meier survival analysis assessed mid- to long-term survival and reoperation rates. Subsequently, the hazard ratio for late mortality and the subdistribution hazard ratio for reoperation, considering death as a competing risk, were calculated.

RESULTS: The study included 981 patients, with 317 in the mitral valve repair group and 664 in the bioprosthetic mitral valve replacement group. After propensity score matching, 254 patients from each group were included. After propensity score matching, patients had a median age of 64 years (interquartile range, 6 years). The mitral valve repair group had significantly shorter operative times, less need for blood transfusions, and lower perioperative reoperation rates. At a median follow-up of 4.8 years, patients undergoing mitral valve repair had comparable late mortality compared with bioprosthetic mitral valve replacement (hazard ratio, 0.637; 95% CI, 0.355-1.143; P = .130). Valve-related reoperation rates and adverse events, except for severe mitral regurgitation, were similar between groups.

CONCLUSIONS: Among patients aged more than 60 years with rheumatic mitral valve disease, valve repair is associated with comparable mid- to long-term survival and perioperative mortality when compared with bioprosthetic valve replacement. Mitral valve repair is regarded as an optional surgical intervention for patients aged more than 60 years who have experienced rheumatic mitral valve disease.