Mitral valve repair versus replacement in patients with rheumatic heart disease

Rheumatic fever is still the main cause of valve disease in developing countries. The study aim was to investigate the appropriateness of mitral valve repair in adult patients with rheumatic heart disease (RHD).

A systematic literature retrieval was performed for all clinical trials comparing the outcomes of mitral valve repair and replacement for RHD in PubMed, EMBASE and the Cochrane Library. Studies were excluded if they lacked a direct comparison of repair versus replacement. The primary outcomes were 30-day and long-term (> 5 years) survival. Secondary outcomes were postoperative complications and reoperation rates. Standard meta-analysis techniques were used.

A total of seven studies was included. When comparing mitral valve repair (MVP) to mitral valve replacement (MVR), the summary odds ratio for 30-day mortality was 0.54 (95% confidence interval (CI) 0.34-0.86; p = 0.009), and the summary hazard ratio (HR) for long-term mortality was 0.62 (95% CI 0.45-0.85; p = 0.003). Other than the benefits of better survival rates, the risk of postoperative complications (cardiac death, bleeding or thromboembolic complications) was also lower in the repair group (HR 0.63; 95% CI 0.47-0.84; p = 0.002). A significantly higher reoperation rate was observed among patients with mitral valve repair (HR 1.85; 95% CI 1.41-2.43; p < 0.01).

Mitral valve repair provides better short-term and long-term event-free survival for rheumatic patients. With an acceptable reoperation rate, MVP is also more beneficial by avoiding troublesome lifelong anticoagulation. Thus, whenever possible, MVP should be attempted in patients with RHD.