Mitral Valve Repair versus Bioprosthetic Replacement Outcomes in patients with Rheumatic Disease Over 60: Propensity Score Matching Results.

Background: Rheumatic mitral valve disease (RMVD) remains a significant health issue in developing countries, especially among elderly patients with severe valvular abnormalities. The optimal surgical intervention-mitral valve repair (MVP) versus bioprosthetic mitral valve replacement (bMVR)-for patients over 60 is debated due to limited studies in this age group. We aimed to compare mid- to long-term outcomes of MVP and bMVR in elderly RMVD patients.

Methods: We retrospectively analyzed patients aged 60 and above who underwent MVP or bMVR at Anzhen Hospital from January 2011 to June 2023. Propensity score matching (PSM) was used to balance the groups. Kaplan-Meier survival analysis assessed mid- to long-term survival and reoperation rates. Subsequently, the hazard ratio (HR) for late mortality and the subdistribution hazard ratio (SHR) for reoperation, considering death as a competing risk, were calculated.

Results: The study included 981 patients, with 317 diagnosed with MVP and 664 with bMVR. After PSM, 254 patients from each group were included. After PSM, patients had a median age of 64 years (IQR: 6 years). The MVP 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, MVP patients had comparable late mortality compared with bMVR (HR: 0.637, 95% CI: 0.355-1.143, p=0.130). Valve-related reoperation rates and adverse events, except for severe mitral regurgitation, were similar between groups.

Conclusion: Among patients aged over 60 years with RMVD, valve repair is associated with comparable mid- to long-term survival rates and perioperative mortality when compared to bioprosthetic valve replacement. MVP is regarded as an optional surgical intervention for patients over the age of 60 who have experienced RMVD.