TITLE:
Mitral Valve Repair versus Mechanical Valve Replacement in a Predominant Rheumatic Population: 14-Year Outcomes and New Insights from a Central African Centre
AUTHORS:
Charles Mve Mvondo, Laurence Carole Ngo Yon, Valerie Ndobo, Amos Ela Bella, Zéphanie Kobe Folkabo, Fabrice Arroye Betou, Jean Claude Ambassa, Cabral Tantchou Tchoumi, William Ngatchou Djomo, Louis Richard Njock
KEYWORDS:
Mitral Valve Repair, Mitral Replacement, Mechanical Valve, Rheumatic Heart Disease, Anticoagulation, Sub-Saharan Africa
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.16 No.4,
April
2,
2026
ABSTRACT: Background: Although non-thrombogenic surgery is advocated over mechanical replacement in underserved populations, long term comparative data have been scarce in the medical literature. Our paper reviews the outcomes of mechanical mitral replacement (MVR) versus repair (MVr) in a Central African institution over a 14-year period. Patients and Methods: We retrospectively analyzed patients undergoing mitral valve surgery between February 2010 and December 2024. Patients were grouped as mechanical MVR or MVr. Patient’s demographics and clinical variables were analyzed. Kaplan-Meier analyses assessed overall survival and freedom from reoperation, hemorrhagic events, neurologic events, and recurrent mitral dysfunction. Groups were compared with the log-rank test. Baseline heterogeneity was assessed using p-values and standardized mean differences (SMD). Results: a total of 231 patients were included (MVR, n = 150 vs MVr, n = 81). The median age (years) at surgery was 27.1 (16.5 - 40.0) and 31.0 (16.0 - 40.6) years for MVR and MVr respectively (p = 0.65). There was female predominance with a sex ratio of 0.76. Rheumatic disease was the predominant etiology in both groups (MVR: 80.6% vs MVr: 76.5%, p = 0.34). Mitral regurgitation (MR) was the commonest lesion in MVr group (97.5% vs 68.7%). The 30-day mortality was 5.1% (n = 12/231; MVR = 8/150, 5.3%; MVr = 4/81, 4.9%). Follow-up represented approximately 1585 patient-years. Kaplan-Meier overall survival at 5 and 10 years was 83.6 ± 2.8% and 74.6 ± 2.7% after mechanical MVR versus 87.3 ± 4.5%, and 78.1 ± 5.2% after MVr (p = 0.29). Freedom from reoperation at 5 and 10 years was 98.8 ± 1.8% and 97.1 ± 2.4% after MVR versus 97.2 ± 2.6% and 95.1 ± 2.9% after MVr. Freedom from hemorrhagic events at 5 and 10 years was 78.7 ± 7.2%% and 72.0 ± 3.0 % after MVR versus 97.1 ± 7.6% after MVr. Freedom from stroke at 5 and 10 years was 94.2 ± 6.8% and 87.8 ± 2.1% after MVR versus 100% after MVr. In the MVr group, freedom from recurrent mitral dysfunction (MR > 2+ or > moderate stenosis) at 5, and 10 years was 97.1 ± 1.8%, and 76.7 ± 3.1%, respectively. Conclusions: Mitral repair, when compared to mechanical replacement seems to provide better outcomes in terms of survival and valve related events even in a predominant rheumatic population.