Abstract
BackgroundMitral regurgitation (MR) is a rather common valvular heart disease. The aim of this systematic review and meta-analysis was to compare the outcomes, and complications of mitral valve (MV) replacement with surgical MV repair of non-ischemic MR (NIMR)MethodsMEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched until October, 2020. Studies were eligible for inclusion if they included patients with MR and reported early (30-day or in-hospital) or late all-cause mortality. For each study, data on all-cause mortality and incidence of reoperation and operative complications in both groups were used to generate odds ratios (ORs) or hazard ratios (HRs). This study is registered with PROSPERO, CRD42018089608.ResultsThe literature search yielded 4834 studies, of which 20 studies, including a total of 21,898 patients with NIMR, were included. The pooled analysis showed that lower age, less female inclusion and incident of hypertension, significantly higher rates of diabetes and atrial fibrillation in the MV replacement group than MV repair group. No significant differences in the rates of pre-operative left ventricle ejection fraction (LVEF) and heart failure were observed between groups. The number of patients in the MV repair group was lower than in the MV replacement group. We found that there were significantly increased risks of mortality associated with replacement of MR. Moreover, the rate of re-operation and post-operative MR in the MV repair group was lower than in the MV replacement group.ConclusionsIn patients with NIMR, MV repair achieves higher survival and leads to fewer complications than surgical MV replacement. In light of these results, we suggest that MV repair surgery should be a priority for NIMR patients.
Highlights
Mitral regurgitation (MR) is a rather common form of mitral valve (MV) dysfunction, occurring in approximately 10% of the population [1]
Selection criteria and data abstraction Studies were considered for inclusion if they met the following criteria: the design was a randomized controlled trials (RCTs) or observational comparative study and the study population included patients with non-ischemic MR (NIMR); patients were assigned to MV replacement versus MV repair; and main outcomes reported included early (30-day or in-hospital) or late (≥6month including early) all-cause mortality
Our results demonstrate that there was no difference in number of preoperative left ventricle ejection fraction (LVEF) (0.03, [− 0.16, 0.23]; p = 0.01, Supplemental Fig. S3A), or heart failure (1.02, [0.77, 1.35]; p = 0.87, Supplemental Fig. S3C) between the two groups, but the number of individuals of New York Heart Association (NYHA) functional class (≥III) in the MV repair group was slightly lower than in the MV replacement group (1.19, [1.01, 1.41]; p = 0.0009, Supplemental Fig. S3B)
Summary
Mitral regurgitation (MR) is a rather common form of mitral valve (MV) dysfunction, occurring in approximately 10% of the population [1]. The majority of surgeons believed that MV repair was of low surgical risk, with few near and long-term adverse events, and offered optimal survival environment and quality of life; and given its ability to preserve the heart’s natural structure intact and achieve optimal cardiac functional reserve, it became the preferred surgical treatment modality for mitral valve disease. Recent data comparing MV repair and replacement failed to demonstrate superiority of MR repair in ischemic MR patients [3]. These findings challenge the benefits and the superiority of MV repair over replacement. The aim of this systematic review and meta-analysis was to compare the outcomes, and complications of mitral valve (MV) replacement with surgical MV repair of non-ischemic MR (NIMR)
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