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To repair or to replace in mitral valve infective endocarditis? an updated meta-analysis
Ahmed K Awad1,2, Karim Wilson3, Mahmoud A Elnagar1
1Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
Background:
Valve infective endocarditis (IE) is a potentially life-threatening condition that affects patients' livelihoods. Current surgical options in mitral valve IE include mitral valve repair (MVr) or replacement (MVR). While each procedure boasts its merits, doubt remains as to which type of surgery is superior.
Methods:
We searched PubMed, Scopus, Web of Science, and Cochrane literature databases for studies comparing MVR and MVr in mitral valve IE. Any randomized controlled trial (RCT) or observational studies that compare MVR vs. MVr in mitral valve IE were eligible. Our dichotomous outcomes were extracted in the form of event and total, and risk and hazard ratio (RR)(HR) with 95% confidence interval (CI) and were pooled and calculated using RevMan 5.0.
Results:
Our study included 23 studies with a total population of 11,802 patients. Compared to MVR, MVr had statistically significant lower risks of both early mortality with RR [0.44; 95% CI, 0.38-0.51; p < 0.001] and long-term follow-up mortality with HR [0.70; 95% CI, 0.58-0.85; p = 0.0004]. Moreover, MVr was associated with a statistically significant lower risk of IE recurrence with RR [0.43; 95% CI, 0.32-0.58; p < 0.001]; however, no statistically significant differences between both groups in terms of re-operations with RR [0.83; 95% CI, 0.41-1.67; p = 0.60].
Conclusion:
Our results suggest that MVr was superior in terms of in-hospital mortality, long-term survival, and risk of recurrence without significance in valve reoperation. Therefore, MVr is appropriate as a primary treatment choice and should be considered whenever possible in most IE patients.
Insights
Mitral valve repair (MVr) is superior to mitral valve replacement (MVR) for infective endocarditis, significantly reducing early and long-term mortality and recurrence risk. MVr is recommended as a primary treatment option.
Area of Science:
- Cardiovascular Surgery
- Infective Endocarditis Research
- Clinical Outcomes Analysis
Background:
- Infective endocarditis (IE) of the mitral valve presents a significant threat to patient well-being.
- Surgical interventions for mitral valve IE include repair (MVr) and replacement (MVR).
- The comparative superiority of MVr versus MVR in mitral valve IE remains a critical clinical question.
Approach:
- A systematic literature search was conducted across PubMed, Scopus, Web of Science, and Cochrane databases.
- Eligible studies included randomized controlled trials and observational studies comparing MVr and MVR for mitral valve IE.
- Dichotomous outcomes were extracted, and risk/hazard ratios with 95% confidence intervals were pooled using RevMan 5.0.
Key Points:
- The analysis encompassed 23 studies involving 11,802 patients.
- Mitral valve repair (MVr) demonstrated significantly lower early mortality (RR [0.44; 95% CI, 0.38-0.51]) and long-term mortality (HR [0.70; 95% CI, 0.58-0.85]) compared to MVR.
- MVr also showed a significantly lower risk of IE recurrence (RR [0.43; 95% CI, 0.32-0.58]), with no significant difference in reoperation rates (RR [0.83; 95% CI, 0.41-1.67]).
Conclusions:
- Mitral valve repair (MVr) is associated with superior outcomes in terms of in-hospital mortality, long-term survival, and reduced risk of recurrence in mitral valve IE.
- The findings support MVr as an appropriate primary treatment choice for most patients with mitral valve IE.
- Consideration of MVr whenever feasible is recommended for optimal patient management.
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