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Mitral valve repair and replacement in infectious endocarditis: a systematic review and meta-analysis of clinical

Umesh Nuthalapati1, Manoj Reddy Bathinapattla1, Rayner Peyser Cardoso2

  • 1Ivano Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.

The Egyptian Heart Journal : (EHJ) : Official Bulletin of the Egyptian Society of Cardiology
|October 4, 2024
PubMed
Abstract

Insights

Mitral valve repair (MVP) is linked to better outcomes than mitral valve replacement (MVR) for infective endocarditis (IE), showing less bleeding, mortality, and stroke. However, MVR may reduce recurrent endocarditis risk.

Area of Science:

  • Cardiovascular Surgery
  • Infectious Diseases
  • Clinical Outcomes Research

Background:

  • Infective endocarditis (IE) presents complex clinical challenges, frequently requiring surgical intervention for optimal patient results.
  • The selection between mitral valve repair (MVP) and mitral valve replacement (MVR) is a critical decision in managing IE patients.

Purpose of the Study:

  • To systematically review and meta-analyze comparative effectiveness of MVP versus MVR in treating IE.
  • To evaluate key outcomes including postoperative bleeding, mortality, recurrent endocarditis, and stroke incidence.

Main Methods:

  • Adherence to PRISMA guidelines for a comprehensive literature search.
  • Inclusion of studies directly comparing MVP and MVR in IE patients.
  • Meta-analysis of data from 32 studies encompassing 82,123 patients using RevMan software.

Main Results:

  • MVP demonstrated significantly lower rates of postoperative bleeding (OR: 0.58) and reduced long-term mortality (OR: 0.40) compared to MVR.
  • MVP was associated with a decreased likelihood of postoperative stroke (OR: 0.52).
  • MVR was associated with lower rates of recurrent endocarditis.

Conclusions:

  • MVP offers significant advantages in reducing postoperative bleeding, long-term mortality, and stroke risk for IE patients.
  • MVR may be preferable in cases where recurrent endocarditis is a primary concern.
  • Treatment decisions should integrate patient-specific factors and surgical expertise; further RCTs are warranted.
Keywords:
Infective endocarditisMeta-analysisMitral valve repairMitral valve replacementOutcomes

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