- Resource Type:
- Presentation
31. Risk of Reoperation Following Rheumatic Mitral Repair: Long-term Longitudinal Analysis
May 3, 2025
Taweesak Chotivatanapong , Commentator , Chest Disease Institute
Masafumi Shibata , Abstract Presenter , Stanford University
105th Annual Meeting, Seattle Convention Center | Summit, Seattle, WA, USA
Seattle Convention Center | Summit, Room 420, Level 4
Abstract
Objective:
Several studies have shown excellent mid-term results of rheumatic mitral valve (MV) repair. However, long-term follow-up data from reasonably sized cohorts are scarce. This study aimed to conduct longitudinal outcome analyses of rheumatic MV repair focusing on the risks of MV reoperation.
Methods:
We evaluated 337 consecutive patients (age 48.5 ± 15.0 years, 236 females) who underwent MV repair for rheumatic MV disease from 2000 to 2022 in a tertiary referral center in South Korea. The primary outcome was MV reoperation. The Fine-Gray models were used for longitudinal risk analyses of MV reoperation with death as the competing risk.
Results:
MV procedure involved ring-annuloplasty (273, 81.0%), commissurotomy (105, 31.2%), release of subvalvular apparatus (13, 3.9%), leaflet pealing (50, 14.8%), chorda procedures (103, 30.6%) and anterior leaflet augmentation (14, 4.2%). Early mortality rate was 1.5% (5/337). During the 20 years follow up period, 52 patients (15.4%) died, resulting in an estimated 20-year survival rate of 78.9% (95% CI, 73.6-84.5) Over a median follow-up period of 15.2 years (Q1-Q3, 7.7-19.4 years; total 4629.71 patient-years), 32 patients required MV reoperation due to development of regurgitation in15, stenosis in 14 and mixed steno-regurgitation in 3. The cumulative risks of reoperation at 10 and 20 years were 4.5% (95% CI, 2.1-6.9) and 12.7% (95% CI, 8.3-17.2), respectively. Multivariable competing risk analyses revealed the following 4 risk factors for reoperation: tricuspid regurgitation velocity > 3.4 m/s (HR 3.26, 95% CI 1.44-7.35, p = 0.005), presence of mitral stenosis >mild at baseline (HR 4.39, 95% CI 2.05-9.4, p < 0.001), leaflet augmentation procedure (HR 5.84, 95% CI 1.97-17.34, p = 0.001) and procedures on chordae (HR 2.99, 95% CI 1.41-6.33, p = 0.004). The 20-year reoperation rates were 1.0% (95% CI 0.0-3.0), 12.7% (95% CI 6.8-18.5), 33.6% (95% CI 16.9-50.3) in the patients without any risk factors, with one risk factor, and with more than one risk factors, respectively. (p < 0.001, Figure).
Conclusion:
The long-term durability of rheumatic MV repair was acceptable, and significant risk factors were pulmonary hypertension, baseline mitral stenosis and procedural factors including leaflet augmentation and chorda procedures. These findings suggest that repair should be preferred over valve-replacement in patients without these risk factors.
Masafumi Shibata (1), Joon Bum Kim (2), Kitae Kim (3), Yoshikazu Ono (4), Hong Rae Kim (5), Ho Jin Kim (6), Jae Suk Yoo (7), Sung-Ho Jung (8), Jae Won Lee (8), (1) Stanford University, Sunnyvale, CA, (2) Asan Medical Center, Seoul, NA, (3) Asan Medical Center, Seoul, South Korea, (4) Stanford University School of Medicine, Palo Alto, CA, (5) Asan Medical Center, Gangnamgu, Seoul, (6) Asan Medical Center, Seoul, Korea, (7) Asan Medical Center, Bucheon-si, Seoul, (8) Asan Medical Center, Seoul
Taweesak Chotivatanapong
Commentator
Bio Dr. Taweesak Chotivatanapong
Dr.Taweesak Chotivatanapong is now The Chairman of International Academic Institute Program and Senior Consultant at Central Chest Institute of Thailand.
He is now also serving as a Head of Cardiothoracic Surgery Department , MedPark Hospital , Bangkok, Thailand. He is a councilor member of the ASCVTS, active member of AATS.
During last several years he set up Heart Care Foundation that he serves as the President of the foundation. The main activities of this foundation are to provide operations for valvular heart patients in the long waiting list and training for young surgeons under " Train The Trainer" program throughout Thailand. Several Center Of Excellences for valve repair are now successfully established under this program.
He also serves as Chairman COE of National Cardiovascular and Thoracic Disease Ministry of Public Health. After received his training for CVT surgery in Thailand, he got his further training in Australia and USA. He is the Former President of Society of Thoracic Surgeons of Thailand.
Most of his research focused on Mitral Valve Repair , Ross operation for infective AV and especially in Rheumatic Valve Repair.
In February 2020, he was the Congress President of the 28th Annual Meeting of The Asian Society of Cardiovascular and Thoracic Surgery (ASCVTS) which was organized in Chiangmai, Thailand. It was very successful and well attended.
Update 2025
Masafumi Shibata
Abstract Presenter
I am a board-certified cardiothoracic surgeon in Japan and a visiting instructor in the Department of Cardiothoracic Surgery at Stanford University School of Medicine.
I am a board-certified cardiothoracic surgeon in Japan and am serving as a visiting instructor in the Department of Cardiothoracic Surgery at Stanford University School of Medicine. My professional expertise centers around cardiovascular surgery, encompassing procedures such as aortic valve replacement (AVR), transcatheter aortic valve replacement (TAVR), coronary artery bypass graft (CABG) surgery, thoracic and endovascular aortic repair (EVAR and TEVAR), and surgical intervention for end-stage heart failure.
My academic background includes Ph.D. studies in cardiovascular surgery, with a specific focus on Platelet-Rich Plasma (PRP) and its role in promoting angiogenesis and enhancing tissue regeneration. I conducted research applying PRP to a rabbit ischemic sternum model, employing a combination of gelatin hydrogel. The findings demonstrated that the controlled release of PRP from locally applied gelatin hydrogel significantly improved sternal healing.
Currently, my research endeavors involve tissue imaging utilizing the Light Sheet Microscope (LSM), where I analyze microstructures and angiogenesis. My career aspiration is to achieve leadership in the field of academic cardiovascular surgery. In my current role, I am dedicated to expanding my academic contributions and furthering my impact in the realm of cardiovascular surgical research.