Mitral valve repair or replacement in native valve endocarditis? Systematic review and meta-analysis

The objective of this study is to review the morbidity and mortality associated with mitral valve repair versus replacement in infective endocarditis patients.

A comprehensive search was undertaken among the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all available data comparing mitral valve repair or replacement in infective endocarditis. Databases were evaluated and assessed to March 2017. Data were analyzed using meta-analytical techniques including odds ratio and mean weighted difference.

A total of 8978 patients were analyzed in a total of 14 articles. The average age of the cohort was 53 years. Results revealed a shorter CPB time in the mitral valve (MV) repair compared to replacement group (P = 0.05). Postoperative outcomes (30 days/in hospital events) such as bleeding (P = 0.0047) and recurrence of infective endocarditis (IE) (P = 0.004) were significantly lower in the MV repair group. Beyond 30 days, recurrence of IE was higher in the MV replacement than the repair group (P < 0.0001). Additionally, there were significantly less reoperations in the repair group (P = 0.0021). The MV repair group had significantly better survival at 1 and 5 years postop (P < 0.0001, P < 0.0001).

This meta-analysis shows that mitral valve repair has good clinical outcomes both in-hospital and at 1 and 5 years of follow-up. Mitral valve repair should be attempted in those patients in whom sufficient valve tissue is present for reconstruction after all infectious tissue has been resected.