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Surgical treatment of active native mitral infective endocarditis: A meta-analysis of current evidence

Jian-Zhou Liu1, Xiao-Feng Li1, Qi Miao1

  • 1Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.

Journal of the Chinese Medical Association : JCMA
|October 21, 2017
PubMed
Abstract

Insights

Mitral valvuloplasty (MVP) may offer better survival outcomes than mitral valve replacement (MVR) for active native mitral infective endocarditis. This meta-analysis suggests MVP is a durable alternative, but further trials are needed.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Infectious Diseases

Background:

  • Active native mitral infective endocarditis (ANMIE) carries a poor prognosis without surgical intervention.
  • Both mitral valvuloplasty (MVP) and mitral valve replacement (MVR) are surgical options for ANMIE.
  • Comparative outcomes between MVP and MVR for ANMIE remain unclear.

Purpose of the Study:

  • To systematically review and compare the outcomes of MVP versus MVR in patients with ANMIE.
  • To evaluate mortality and survival rates as primary endpoints for both surgical approaches.

Main Methods:

  • A systematic literature review identified comparative observational studies on MVP versus MVR for ANMIE.
  • Data on patient characteristics, surgical methods, and follow-up were extracted.
  • Pooled odds ratios (OR) and hazard ratios (HR) were calculated to compare outcomes, with publication bias assessed.

Main Results:

  • Nine studies involving 633 patients (265 MVP, 368 MVR) were analyzed.
  • MVP was associated with significantly lower operative mortality (OR 0.37, p=0.0005).
  • MVP showed improved 1- and 5-year event-free survival (HR 0.43, p=0.03; HR 0.44, p=0.004) and overall survival (HR 0.55, p=0.004 at 5 years).

Conclusions:

  • Mitral valvuloplasty (MVP) appears to be associated with superior postoperative survival compared to mitral valve replacement (MVR) in ANMIE.
  • MVP is a desirable and potentially more durable alternative to MVR when feasible.
  • Further powered clinical trials are necessary to confirm these findings, considering patient characteristics and surgeon preferences.
Keywords:
Infective endocarditisMeta-analysisMitral valve replacementMitral valvuloplasty

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