Re-repair vs. Replacement for Failed Mitral Valve Repair: A Systemic Review and Meta-Analysis

Abstract

ObjectiveThe objective of this study was to compare outcomes of re-repair with those of mitral valve replacement (MVR) for failed initial mitral valve repair (MVr).MethodsWe searched the Pubmed, Embase, and Cochrane Library databases for studies that compared mitral valve re-repair with MVR for the treatment of failed initial MVr. Data were extracted by two independent investigators and subjected to a meta-analysis. Odds ratio (OR), risk ratio (RR), hazard ratio (HR), ratio difference (RD), mean difference (MD), and 95% confidence interval (CI) were calculated with the Mantel-Haenszel and inverse-variance methods for mode of repair failure, perioperative outcomes, and follow-up outcomes.ResultsEight retrospective cohort studies were included, with a total of 938 patients, and mean/median follow-up ranged from 1.8 to 8.9 years. Pooled incidence of technical failure was 41% (RD: 0.41; 95% CI: 0.32 to 0.5; P = 0.00; I2 = 86%; 6 studies, 846 patients). Pooled mitral valve re-repair rate was 36% (RD: 0.36; 95% CI: 0.26–0.46; P = 0; I2 = 91%; 8 studies, 938 patients). Pooled data showed significantly lower perioperative mortality (RR: 0.22; 95% CI: 07 to 0.66; I2 = 0%; P = 0.008; 6 studies, 824 patients) and significantly lower long-term mortality (HR:0.42; 95% CI: 0.3 to 0.58; I2 = 0%; P = 0; 7 studies, 903 patients) in the re-repair group compared with MVR.ConclusionsMitral valve re-repair was associated with better immediate and sustained outcomes for failed MVr and should be recommended if technically feasible.

Transcatheter Mitral Valve Repair for Failed Surgical Mitral Valve Repair: A Systematic Review and Meta-Analysis

“…For secondary MR, the proof of surgical correction was limited, but different techniques of subvalvular repair were being evaluated. For failed MVr, re-repair was also associated with significantly lower peri-operative mortality and improved late survival compared with MVR [4].…”

“…Redo mitral valve surgery has been the golden standard for failed MVr before the era of percutaneous interventions [4]. However, it was associated with higher perioperative risk.…”

“…The immediate and sustained results of surgical re-repair had been proven to be excellent. At 5 years after surgical re-repair, MR recurrence occurred in less than 10% of patients; freedom from reoperation was 83%~96% and survival was 76%~100% [4]. Considering the short follow-up duration of the pooled studies, the durability of TMVr for failed MVr should be further examined and compared with surgical re-repair.…”

“…Besides edge-to-edge repair, there was also growing evidence for transcatheter procedures targeting the annulus and the chordae [28]. In open MV re-repair surgery, the frequently used techniques included leaflet resection, ring removal/annuloplasty, edgeto-edge repair, and neochordae [4,27].…”

“…However, MVr carries a potential risk for reoperation, reducing late survival [3]. Redo surgery including MVr and mitral valve replacement (MVR) has been the gold standard for failed surgical MVr, defined by the recurrence of moderate or severe MR, mitral valve re-operation for any reason, such as mitral regurgitation, stenosis, hemolysis, or infective endocarditis [4]. However, it is associated with increased technical difficulty inherent to reoperations and greater frailty of the patients [5,6].…”