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Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Clinical outcomes following surgical mitral valve plasty or replacement in patients with infectious endocarditis: A
Song Wang1,2, Ting Zhou3, Jinhui Bian2
1Department of Cardiovascular Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Nanjing, China.
Background:
For degenerative mitral disease, more and more evidences support that mitral valve plasty (MVP) has much better clincial outcomes than mitral valve replacement (MVR). However, the advantages of MVP in patients suffering from infectious endocarditis (IE) are unclear. To evaluate the appropriateness of MVP in IE patients, we conducted this meta-analysis. Based on the difference between active and healed phase, we not only compared the result of patients with IE, but also identified the subgroup with active IE.
Methods:
We systematically searched the clinical trials comparing clinical outcomes of MVP and MVR in patients suffering from IE. Relevant articles were searched from January 1, 2000 to March 18, 2021 in Pubmed and Cochrane Library. Studies were excluded if they were with Newcastle-Ottawa Scale (NOS) score less than 6 or lacking of direct comparisons between MVP and MVR.
Results:
23 studies were involved and 25,615 patients were included. Pooled analysis showed fewer adverse events and early or long-term death in the MVP group. However, more reoperations existed in this patient group. And the reinfection rate was close between two groups. Similar results were observed after identifying active IE subgroup, but there is no difference in the freedom from reoperation due to all-events.
Conclusions:
Although limitimations exited in this study, patients suffering from IE can benefit from both MVP and MVR. For surgeons with consummate skills, MVP can be the preferred choice for suitable IE patients.
Insights
Mitral valve plasty (MVP) offers better outcomes and lower mortality than mitral valve replacement (MVR) for infectious endocarditis (IE) patients. MVP may be preferred by skilled surgeons for suitable IE cases, despite higher reoperation rates.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Medical Research
Background:
- Degenerative mitral disease often favors mitral valve plasty (MVP) over mitral valve replacement (MVR).
- The efficacy of MVP in patients with infectious endocarditis (IE) remains uncertain.
- This meta-analysis evaluates MVP appropriateness in IE patients, including active IE subgroups.
Purpose of the Study:
- To compare clinical outcomes of MVP versus MVR in patients with IE.
- To assess the safety and efficacy of MVP in active IE cases.
- To determine the preferred surgical approach for IE patients.
Main Methods:
- Systematic literature search of clinical trials comparing MVP and MVR in IE patients (Jan 2000 - Mar 2021).
- Inclusion criteria: Newcastle-Ottawa Scale score ≥ 6, direct MVP vs. MVR comparison.
- Exclusion criteria: low-quality studies or indirect comparisons.
Main Results:
- 23 studies and 25,615 patients analyzed.
- MVP group showed fewer adverse events and reduced mortality (early/long-term).
- MVP group had higher reoperation rates; reinfection rates were similar between groups. Active IE subgroup analysis yielded comparable results, with no significant difference in freedom from reoperation.
Conclusions:
- Both MVP and MVR benefit IE patients.
- MVP is a viable option for suitable IE patients, particularly when performed by experienced surgeons.
- Further research may clarify optimal surgical strategies for specific IE patient profiles.
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