Similar Survival After Mitral Valve Replacement or Repair for Ischemic Mitral Regurgitation: A Meta-Analysis

Dayan, Víctor; Soca, Gerardo; Cura, Leandro; Mestres, Carlos A.

doi:10.1016/j.athoracsur.2013.10.044

Cited by 58 publications

(49 citation statements)

References 32 publications

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“…Published literature provides a wide range of results in terms of early outcomes. Several recent experiences found no significant difference between the two surgical managements, this is in accordance with the present observations [2,18], whereas several studies showed that mitral valve repair is associated with lower operative mortality and postoperative complications [19,20]. After adjustment for baseline differences with Cox proportional hazard model analysis, the present long-term observational study showed no substantial difference between the two managements of risk for MACCE, cardiac death, or overall death.…”

Section: Discussionsupporting

confidence: 80%

“…Follow-up echocardiographic results of PS-matched patients showed that, compared with the MVR group, both the left atrium and left ventricle end-diastolic diameter were markedly larger, and the incidence of MR recurrence was significantly higher in the MVA group. MVR provides a considerably more durable correction of MR than MVA [2,19], which may have a beneficial effect on long-term outcomes. However, this effect must be weighed against any potential adverse consequences of a prosthetic valve, such as long-term thromboembolism, endocarditis, and structural valve deterioration [2].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Long-term outcomes of mitral valve annuloplasty versus subvalvular sparing replacement for severe ischemic mitral regurgitation

Sun

et al. 2019

Cardiol J

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of mitral valve annuloplasty versus subvalvular sparing replacement for severe ischemic mitral regurgitation

Sun

et al. 2019

Cardiol J

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“…Both MV repair and replacement are effective surgical methods for MV disease, which may be caused by degenerative MV disease, rheumatic MV disease and ischemic MV disease. The superiority of MV repair over replacement has been well established in patients with degenerative MV disease (18), in terms of lower hospital mortality (19), improved early and late survival rates, and fewer adverse postoperative complication (20). However, the optimal procedure for patients with rheumatic MV disease remains controversial.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of late outcomes of mitral valve repair in patients with rheumatic heart disease

Fu¹,

Popal²,

Zhang³

et al. 2017

J. Thorac. Dis.

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Background: Rheumatic heart disease (RHD) is a predominant health concern in developing countries.The aim of this meta-analysis was to evaluate the outcomes of mitral valve (MV) repair in patients with RHD, and identify predictors that may postoperatively affect treatment outcome. Methods: A meta-analysis of eligible studies assessing patients undergoing MV repair with RHD and reporting the outcomes of MV repair, including 30-day mortality and long-term follow-up survival, MV reoperation rate and postoperative adverse events. Relevant English articles were searched up to 1 March, 2017 in Web of Science, PubMed, Google Scholar, Cochrane Library, EmBase, Elsevier, and Science Direct.Selected studies should meet all inclusion criteria, and underwent data extraction. Results: A total of ten studies with 2,770 patients met all inclusion criteria, and were selected for assessment. Pooled analysis showed that 30-day mortality in patients with rheumatic MV disease after MV repair surgery was 1.9%, 95% confidence interval (CI) (0.8-2.9%); long-term survival was 97.3%, 95% CI (95.9-98.6%), and a freedom from reoperation rate of 93.6%, 95% CI (91.4-95.9%) was obtained; freedom from adverse events was 97.5%, 95% CI (95.2-99.8%). Conclusions:The outcome of rheumatic MV repair is outstanding in terms of low early mortality, high long-term survival and freedom from valve-related complications, which may be very common in patients after rheumatic MV replacement; meanwhile, MV reoperation rate after initial surgery is acceptable. Surgeons may try to repair MV in RHD when it is feasibleKeywords: Rheumatic heart disease (RHD); mitral valve (MV) repair; outcomes; meta-analysis J Thorac Dis 2017;9(11):4366-4375 jtd.amegroups.com feasibility of MV repair for RHD patients is extremely low. However, other studies (3,4) believed that MV replacement may not be the most optimal surgical treatment for such patients, demonstrating the advantages of MV repair over replacement in terms of low rate of early mortality, better late survival, preservation of left ventricular function, and reduced anticoagulant-related complications. Here, we systematically reviewed published literature and performed a meta-analysis which assessed the outcomes of MV repair in patients with RHD, exploring predictive factors that may postoperatively affect treatment outcome. Methods Literature searchWeb of Science, PubMed, Cochrane Library, Google Scholar, EmBase, Elsevier, and ScienceDirect were independently searched by two authors (JT Fu, MS Popal) for potentially relevant studies which analyzed the outcomes of MV repair for rheumatic MV disease, up to 1 March, 2017. The following key terms were used either alone or in combination: "rheumatic heart disease", "RHD", "mitral valve repair", "MVP", "mitral valve reconstruction", and "mitral valve surgery". Some references in relevant studies were hand searched for additional articles which could not be identified by the advanced search. Selection criteriaThe inclusion criteria were: (I) directly analysis of MV repair...

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“…The role of MV‐repair for functional (ischemic) MV regurgitation is still under debate2, 3 and in rheumatic disease mainly MVR is performed, as MV‐repair is more complex in these patients and less durable 4. Due to the demographic changes in Western communities and a higher incidence of MV disease in the elderly population,5 the age of patients referred for MV surgery is increasing.…”

Section: Introductionmentioning

confidence: 99%

Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short‐ and Long‐Term Outcomes in a Propensity‐Matched Cohort

Silaschi

Chaubey

Aldalati

et al. 2016

JAHA

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BackgroundBecause of demographic changes, a growing number of elderly patients present with mitral valve (MV) disease. Although mitral valve repair (MV‐repair) is the “gold standard” treatment for MV disease, in elderly patients, there is controversy about whether MV‐repair is superior to mitral valve replacement. We reviewed results after MV surgery in elderly patients treated over the past 20 years.Methods and ResultsOur in‐hospital database was explored for patients who underwent MV surgery between 1994 and 2015. Survival data, obtained from the National Health Service central register, were complete for all patients. Of 1776 patients with MV disease, 341 were aged ≥75 years. Patients with repeat cardiac surgery, endocarditis, and concomitant aortic valve replacement were excluded. This yielded 221 MV‐repair and 120 mitral valve replacement patients. Concomitant procedures included coronary artery bypass grafting in 135 patients (39.6%) and tricuspid valve surgery in 50 patients (14.7%). Thirty‐day mortality was 5.4% (MV‐repair) versus 9.2% (mitral valve replacement, P=0.26). Overall 1‐ and 5‐year survival was 90.7%, 74.2% versus 81.3%, 61.0% (P<0.01). Median survival after MV‐repair was 7.8 years, close to 8.5 years (95% CI: 8.2–9.4) in the age‐matched UK population (ratio 0.9). Rate of re‐operation for MV‐dysfunction was 2.3% versus 2.5% (mitral valve replacement, P=1.0). After propensity matching, patients after MV‐repair still had improved survival at 1, 2, and 5 years (93.4%, 91.6%, 76.9% versus 77.2%, 75.2%, 58.7%, P=0.03).ConclusionsExcellent outcomes can be achieved after MV surgery in elderly patients. Long‐term survival is superior after MV‐repair and the re‐operation rate is low. MV‐repair should be the preferred surgical approach in elderly patients.

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Similar Survival After Mitral Valve Replacement or Repair for Ischemic Mitral Regurgitation: A Meta-Analysis

Cited by 58 publications

References 32 publications

Long-term outcomes of mitral valve annuloplasty versus subvalvular sparing replacement for severe ischemic mitral regurgitation

Long-term outcomes of mitral valve annuloplasty versus subvalvular sparing replacement for severe ischemic mitral regurgitation

A meta-analysis of late outcomes of mitral valve repair in patients with rheumatic heart disease

Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short‐ and Long‐Term Outcomes in a Propensity‐Matched Cohort

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