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A meta-analysis of mitral valve repair versus replacement for ischemic mitral regurgitation

Sohaib A Virk1, Arunan Sriravindrarajah1, Douglas Dunn1

  • 11 The Systematic Review Unit, The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiology, 3 Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia.

Annals of Cardiothoracic Surgery
|November 6, 2015
PubMed
Abstract

Insights

Mitral valve repair (MVr) for ischemic mitral regurgitation (IMR) reduces peri-operative and late mortality compared to mitral valve replacement (MVR). However, MVr is associated with a higher recurrence of moderate mitral regurgitation.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Research

Background:

  • Ischemic mitral regurgitation (IMR) is linked to poor prognosis and adverse long-term outcomes.
  • Surgical management of IMR includes mitral valve repair (MVr) and mitral valve replacement (MVR), with ongoing debate regarding the optimal approach.

Purpose of the Study:

  • To conduct a meta-analysis comparing MVr and MVR for IMR, with mortality as the primary endpoint.

Main Methods:

  • Systematic search of seven databases for studies on peri-operative or late mortality following MVr and MVR for IMR.
  • Independent data extraction by two reviewers and meta-analysis of selected studies.

Main Results:

  • Meta-analysis of 22 observational studies and one RCT (3,815 patients) showed significantly reduced peri-operative mortality (RR 0.61) and late mortality (RR 0.78) with MVr.
  • The benefits of MVr on mortality were more pronounced in studies with follow-up exceeding 3 years.
  • Higher recurrence of at least moderate mitral regurgitation (MR) was observed with MVr (RR 5.21), while mitral valve re-operation rates were similar.

Conclusions:

  • Mitral valve repair (MVr) is associated with reduced peri-operative and late mortality compared to mitral valve replacement (MVR) for IMR.
  • Despite increased MR recurrence with MVr, similar re-operation rates were noted.
  • Further large prospective studies are needed to fully compare long-term survival and re-intervention rates, considering patient characteristics influencing treatment allocation.
Keywords:
Mitral valve repair (MVr)ischemic mitral regurgitation (IMR)meta-analysismitral valve replacement (MVR)

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