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Mitral Valve Replacement Using Subvalvular Apparatus: A Systematic Review and Meta-Analysis
Wan Chin Hsieh1, Anas Aboud2, Brandon Michael Henry3
1First Faculty of Medicine, Charles University, Prague, Czech Republic; 2nd Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
The Heart Surgery Forum
|June 12, 2020
Summary
Preserving the subvalvular apparatus during mitral valve replacement (MVR) significantly lowers long-term mortality. This approach also improves outcomes like hospital length of stay and reduces pneumonia and bleeding risks.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
Background:
- Mitral valve replacement (MVR) is a common cardiac procedure.
- Preservation of the subvalvular apparatus during MVR is a surgical technique with potential clinical benefits.
Purpose of the Study:
- To assess the clinical outcomes of mitral valve replacement (MVR) with preservation of the subvalvular apparatus.
- To compare outcomes between MVR with subvalvular apparatus preservation and standard MVR.
Main Methods:
- A comprehensive meta-analysis was conducted.
- Included 21 studies with 5,106 participants.
- Utilized data from multiple electronic databases and RevMan software for analysis.
Main Results:
- Preservation of the subvalvular apparatus significantly reduced long-term mortality (OR: 0.46; 95% CI: 0.33-0.64).
- No significant differences were observed in early mortality, ejection fraction, stroke, renal failure, or pneumonia.
- Limited data exists for bleeding, sepsis, and nosocomial infections.
Conclusions:
- Mitral valve replacement with subvalvular apparatus preservation improves clinical outcomes, including reduced long-term mortality, shorter hospital stays, and decreased pneumonia and bleeding.
- Key adverse events like stroke and renal failure showed no significant difference.
- Further research is needed to fully understand the impact on bleeding, sepsis, and nosocomial infections.
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