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Mitral valve repair versus replacement in elderly patients: a systematic review and meta-analysis

Xiaoke Shang1, Rong Lu2, Mei Liu2

  • 1Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.

Journal of Thoracic Disease
|December 10, 2017
PubMed
Abstract

Insights

Mitral valve repair (MVP) offers better early and late outcomes for elderly patients compared to mitral valve replacement (MVR). This meta-analysis suggests MVP is the preferred surgical strategy for this demographic.

Area of Science:

  • Cardiovascular Surgery
  • Geriatric Medicine
  • Clinical Outcomes Research

Background:

  • Mitral valve repair (MVP) is standard for mitral valve disease.
  • Debate exists on MVP vs. mitral valve replacement (MVR) in older patients.
  • Elderly patients (≥70 years) require comparative outcome data.

Purpose of the Study:

  • To compare mitral valve repair (MVP) versus mitral valve replacement (MVR) in elderly patients.
  • To evaluate early and late outcomes of MVP compared to MVR.
  • To inform surgical strategy for mitral valve disease in the geriatric population.

Main Methods:

  • Systematic literature search of PubMed, Cochrane Library, and Scopus up to February 2017.
  • Inclusion of observational studies comparing MVP vs. MVR in patients aged 70 years or older, published after 2000.
  • Meta-analysis of seven studies involving 1,809 patients.

Main Results:

  • Mitral valve repair (MVP) was associated with significantly reduced 30-day mortality (RR: 0.40) and fewer postoperative complications (RR: 0.69) compared to MVR.
  • MVP resulted in shorter postoperative hospital stays (WMD: -1.47 days).
  • Improved 1-year (RR: 1.16) and 5-year (RR: 1.26) survival rates were observed with MVP; no difference in reoperations.

Conclusions:

  • Mitral valve repair (MVP) demonstrates superior early and late outcomes in elderly patients compared to mitral valve replacement (MVR).
  • MVP may be the preferred surgical approach for mitral valve disease in the elderly.
  • Evidence supports MVP as a beneficial strategy for geriatric patients undergoing mitral valve surgery.
Keywords:
Mitral valve repair (MVP)elderlymeta-analysismitral valve replacement (MVR)

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