Similar Survival After Repair vs Replacement for Ischemic Mitral Regurgitation

To determine whether mitral valve (MV) repair improves early and late survival compared with MV replacement for patients with ischemic mitral regurgitation (IMR), we performed a meta-analysis of randomized controlled trials (RCTs) and adjusted observational studies. Databases including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through January 2016 using PubMed and Ovid. Studies considered for inclusion met the following criteria: the design was a RCT or adjusted observational study, the study population was patients with IMR; patients were assigned to MV repair vs replacement, and outcomes included early (30 days or in hospital) or late (≥1 year) overall survival or all-cause mortality. An adjusted odds or hazard ratio (OR/HR) with its 95% CI of early or late (including early) all-cause mortality for MV repair vs replacement was abstracted from each individual study. Our search identified 12 articles from one RCT and 10 adjusted observational studies including 2784 patients. Pooled analyses demonstrated no significant difference in both early (OR = 0.90; 95% CI: 0.69-1.16; P = 0.41) and late mortality (HR = 0.90; 95% CI: 0.72-1.13; P = 0.38) between MV repair and replacement. Exclusion of any single study from the meta-analysis did not substantively alter the overall result of no significant difference. There was no evidence of significant publication bias. For patients with IMR, MV repair appears to be unassociated with a significant decrease in both early and late all-cause mortality compared with MV replacement.