Clinical outcomes following surgical mitral valve repair or replacement in patients with rheumatic heart disease: a meta-analysis

Abstract

Background: The clinical outcome of mitral valve repair (MVP) is considerably more favorable than that of mitral valve replacement (MVR) in patients with degenerative mitral disease. However, rheumatic heart disease (RHD) is still the predominant cause of mitral valve surgery in developing countries and the advantages of MVP in RHD have still not been definitely proven. The aim of this meta-analysis was thus to evaluate the suitability of MVP in patients with RHD. Considering the difference between mechanical and biological valves, we distinguished them from each other and compared them with MVP individually. Methods: A comparison of clinical outcomes of MVP and MVR in patients with RHD was performed based on clinical trial data. Relevant articles published from January 1, 1990 until March 1, 2020 were identified in Pubmed, Cochrane Library, and China National Knowledge Infrastructure database (CNKI).Studies that lacked direct comparisons between MVP and MVR were excluded.Results: A total of 16 studies with 8659 patients were included in the analysis. The MVP group displayed lower early and long-term mortality, and fewer valve-related events and major adverse events. However, this patient group required more reoperations compared with the MVR group. Similar results were observed after distinguishing between mechanical and bioprosthetic valves to compare MVP with MVR (mech-valves), but no statistically significant difference was identified in the reoperation rate between MVP and MVR (bio-valves). MVP was further associated with increased risk of mitral reoperation in patients undergoing concomitant aortic valve replacement (AVR) surgery but without any improved early and long-term survival.Conclusions: MVP and MVR are beneficial for patients with RHD. For skilled surgeons, MVP can be performed for some suitable patients with RHD and is preferred for elderly patients or patients with contraindications of anticoagulation. However, MVR is more appropriate when concomitant AVR is needed.

Clinical outcomes following surgical mitral valve plasty or replacement in patients with infectious endocarditis: A meta-analysis

“…Repair and replacement are both candidate therapeutic methods for valve diseases. More and more surgeons prefer MVP as the first choice for patients with myxomatous, ischemic or degenerative mitral valve diseases, due to MVP's advantages of lower early morbidity and operative mortality, higher long-term survival, and fewer reoperation events ( 4 ). However, the superiority of MVP in patients with IE still needs identification furtherly.…”

“…Thirdly, the possiblity of valve-related events and perivalvular leakage was reduced by the existence of autogenous valves. Fourthly, it helps patients avoding thromboembolism and hemorrhage with no need for long-term use of anticoagulant therapy ( 4 ). Besides, surgeons' preference for MVP in patients with superior body condition and less damaged valves also contribute to fewer complications and death, which can be reflected by the fact that patients receiving MVP are normally younger.…”

“…The indications for surgery in IE are well defined but the choice of surgical procedures is less defined, especially with regard to MVP vs. MVR ( 3 ). For non-infected mitral valvular diseases, such as myxomatous, ischemic or degenerative valve disease, MVP is prefered due to fewer reoperation, thromboembolism, and valve infection events ( 4 ). While for patients with IE, although several studies have confirmed a better survival after MVP compared with MVR in patients with IE, the small sample size and lacking of randomized controlled trials bring the bias and reduce the confidence level.…”

Mechanical versus Bioprosthetic Aortic Valve Replacement in Middle-Aged Adults: A Systematic Review and Meta-Analysis

“…All valve-related events are reported in accordance with the revised guidelines published by the “Ad. Hoc Liaison Committee for Standardizing Definitions for Prosthetic Heart Valve Morbidity (2008)” [ 11 , 30 ]. Five studies [ 8 , 12 , 15 , 22 , 24 ] provided sufficient details to allow the extraction of HR and their standard errors.…”

“…The summary HR for long-term survival, freedom from cardiac death, freedom from reoperation, freedom from valve-related events, freedom from bleeding, and freedom from stroke and OR for early mortality were obtained as weighted averages of the measures from the individual studies, with inverse variances used as weights in the usual manner. The methods of Parmer et al, Williamson et al, and Tierney et al were used to calculate the estimated HR and its variance [ 11 ]. A Q-statistic and an I2 (Index of Inconsistency) test were used to quantify the degree of heterogeneity in all studies.…”