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Valve replacement or repair in native mitral valve infective endocarditis-Which is better? A meta-analysis and

Kang He1, Juelin Song1, Hongying Luo1

  • 1Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.

Journal of Cardiac Surgery
|January 15, 2022
PubMed
Abstract

Insights

Mitral valve repair (MVP) offers better outcomes than mitral valve replacement (MVR) for infective endocarditis, reducing mortality and improving survival. MVP is a suitable primary treatment choice for most patients.

Area of Science:

  • Cardiovascular Surgery
  • Infectious Diseases
  • Medical Statistics

Background:

  • Native mitral valve infective endocarditis (IE) presents significant challenges due to high mortality and recurrence rates.
  • Surgical interventions, primarily mitral valve repair (MVP) and mitral valve replacement (MVR), are standard treatments, but their comparative efficacy remains debated.

Purpose of the Study:

  • To systematically review and compare the early and long-term outcomes of MVP versus MVR in patients with native mitral valve IE.
  • To determine which surgical approach offers superior survival rates and reduces the risk of complications.

Main Methods:

  • A meta-analysis and systematic review of studies from PubMed, Embase, and Cochrane databases.
  • Data extraction included baseline characteristics, mortality, survival, recurrent endocarditis, and reoperation rates.
  • Risk ratios (RR) and hazard ratios (HR) were calculated to assess treatment effects.

Main Results:

  • Analysis of 17 studies involving 3759 patients (1180 MVP, 2579 MVR).
  • MVP was associated with significantly lower early mortality (RR, 0.51) and improved long-term survival (HR, 0.69).
  • MVP showed a trend towards lower recurrence risk (RR, 0.66), with similar reoperation rates compared to MVR.

Conclusions:

  • Mitral valve repair (MVP) appears to yield better outcomes than mitral valve replacement (MVR) for native mitral valve infective endocarditis.
  • MVP is recommended as a primary treatment option, potentially reducing in-hospital mortality, enhancing long-term survival, and lowering recurrence risk.
Keywords:
infective endocarditismeta-analysismitral valverepairreplacement

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