{
  "abstract": "Background Rheumatic mitral valve disease remains a major global health challenge. Determining optimal surgical approaches is critical. This study aimed to identify key repairability factors and compare midterm outcomes of mitral repair versus replacement.Methods This retrospective cohort study consecutively enrolled rheumatic mitral valve surgery patients from two centres, excluding those with missing imaging or clinical data. CT angiography and echocardiogram was used to quantitatively assess factors affecting repairability. Inverse probability weighting was applied to balance baseline characteristics between groups, and mid-term outcomes were compared. Independent risk factors for prognosis were also explored.Results Among 972 patients, 621 (63.9%) successfully underwent mitral valve repair. Body mass index, diabetes, left atrial diameter, posterior leaflet calcification, anterior leaflet clear zone calcification and annular calcification were identified as independent factors affecting repairability. At a median follow-up of 3.51 years (IQR 1.62–5.14), the repair group demonstrated more favourable outcomes, with significantly reduced mortality and stroke rates compared with the replacement group, while maintaining comparable reoperation rates. Prior percutaneous mitral commissurotomy did not reduce valve repairability (OR=0.588, 95% CI 0.342 to 1.010; p=0.054) but emerged as an independent predictor of reoperation following repair (OR=7.496, 95% CI 1.325 to 42.404; p=0.023).Conclusions In well-selected patients, rheumatic mitral valve repair was associated with lower mortality and stroke rates compared with replacement, with comparable reoperation rates. However, patients with a history of percutaneous mitral commissurotomy have a higher risk of reoperation after repair and should be carefully evaluated.Trial registration number ChiCTR2200067151.",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China",
        "Beijing Laboratory of Cardiovascular Precision Medicine, Beijing Municipal Education Commission, Beijing, China"
      ],
      "name": "Songhao Jia"
    },
    {
      "affiliations": [
        "Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China",
        "Beijing Laboratory of Cardiovascular Precision Medicine, Beijing Municipal Education Commission, Beijing, China"
      ],
      "name": "Peiyi Liu"
    },
    {
      "affiliations": [
        "Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China",
        "Beijing Laboratory of Cardiovascular Precision Medicine, Beijing Municipal Education Commission, Beijing, China"
      ],
      "name": "Maozhou Wang"
    },
    {
      "affiliations": [
        "Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China",
        "Beijing Laboratory of Cardiovascular Precision Medicine, Beijing Municipal Education Commission, Beijing, China"
      ],
      "name": "Xiaohan Zhong"
    },
    {
      "affiliations": [
        "Beijing Laboratory of Cardiovascular Precision Medicine, Beijing Municipal Education Commission, Beijing, China",
        "Department of Physiology & Pathophysiology, School of Basic Medical Sciences, Capital Medical University, Beijing, China"
      ],
      "name": "Meili Wang"
    },
    {
      "affiliations": [
        "Beijing Laboratory of Cardiovascular Precision Medicine, Beijing Municipal Education Commission, Beijing, China",
        "Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Wei Luo"
    },
    {
      "affiliations": [
        "Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China",
        "Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China"
      ],
      "name": "Yuyong Liu"
    },
    {
      "affiliations": [
        "Department of Cardiothoracic Surgery, Zhongshan City People’s Hospital, Zhongshan, Guangdong, China"
      ],
      "name": "Hongyu Ye"
    },
    {
      "affiliations": [
        "Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China",
        "Beijing Laboratory of Cardiovascular Precision Medicine, Beijing Municipal Education Commission, Beijing, China"
      ],
      "name": "Hongjia Zhang"
    },
    {
      "affiliations": [
        "Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China",
        "Beijing Laboratory of Cardiovascular Precision Medicine, Beijing Municipal Education Commission, Beijing, China"
      ],
      "name": "Wenjian Jiang"
    }
  ],
  "title": "Midterm outcomes of rheumatic mitral valve repair versus replacement in a dual-centre retrospective study",
  "uid": "e8c46b58-d72b-5939-96a1-14508715ac4c"
}