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Mitral Valve Repair Is Durable in Patients With Rheumatoid Arthritis.
MedLine Citation:
PMID:  22607783     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
John M Stulak; Rakesh M Suri; Eric L Matteson; Joseph A Dearani; Heidi M Connolly; Hartzell V Schaff
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-5-16
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  -     ISSN:  1552-6259     ISO Abbreviation:  -     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-5-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minnesota.
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