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Mitral valve repair versus replacement in severe ischemic mitral regurgitation systematic review and meta-analysis

Mohamed A Gamal1, Mohamed M El-Fiky1, Mahmoud M Gamea1

  • 1Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Journal of Cardiac Surgery
|April 2, 2022
PubMed
Abstract

Insights

Mitral valve repair (RPR) may offer better perioperative survival for ischemic mitral regurgitation (IMR), but replacement (RPL) significantly reduces MR recurrence. The optimal surgical strategy requires careful consideration of these outcomes.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Research

Background:

  • Ischemic mitral regurgitation (IMR) is a significant complication of coronary artery disease.
  • The optimal surgical approach for IMR, whether mitral valve repair (RPR) or replacement (RPL), remains a subject of debate.
  • This meta-analysis compares RPR and RPL outcomes in IMR patients.

Purpose of the Study:

  • To compare the perioperative and overall mortality rates of RPR versus RPL for IMR.
  • To evaluate differences in reoperation rates, mitral regurgitation (MR) recurrence, and reverse remodeling between RPR and RPL.
  • To provide evidence-based insights for surgical decision-making in IMR.

Main Methods:

  • Systematic electronic literature searches were conducted in Google Scholar, PubMed, and Embase.
  • Key search terms included mitral valve, IMR, RPR, RPL, and coronary artery bypass grafting.
  • Primary outcomes assessed were perioperative mortality, overall mortality, reoperation, MR recurrence, and reverse remodeling.

Main Results:

  • A trend towards lower perioperative mortality was observed in the RPR group, though not statistically significant (OR 0.66; 95% CI 0.41-1.07; p=0.09).
  • Patients undergoing RPR experienced a significantly higher rate of MR recurrence compared to those who had RPL (OR 16.8; 95% CI 5.07-55.7; p=0.00001).

Conclusions:

  • Mitral valve repair (RPR) shows a trend towards reduced perioperative mortality in IMR patients.
  • Mitral valve replacement (RPL) is associated with significantly lower rates of MR recurrence.
  • The choice between RPR and RPL for IMR necessitates balancing perioperative risks with long-term recurrence rates.
Keywords:
ischemic mitral regurgitationmitral valve repairmitral valve replacement

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