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Mitral Valve Repair Versus Replacement in Patients Undergoing Concomitant Aortic Valve Replacement
Yi Zhang1, Guangguo Fu1, Gang Li1
1Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Heart, Lung & Circulation
|November 29, 2024
Summary
Aortic valve replacement plus mitral valve repair (AVR plus MVr) offers better long-term survival and fewer complications than double valve replacement (DVR). However, rheumatic heart disease patients may require higher reoperation rates with AVR plus MVr.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Disease
- Meta-Analysis
Background:
- Mitral valve repair (MVr) generally yields better long-term outcomes than mitral valve replacement (MVR) for isolated mitral valve disease.
- The benefit of MVr in patients with combined aortic and mitral valve disease remains debated.
Purpose of the Study:
- To compare the survival benefits of aortic valve replacement (AVR) plus MVr versus double valve replacement (DVR).
- To evaluate early mortality, reoperation rates, and valve-related adverse events.
Main Methods:
- A meta-analysis of studies comparing AVR plus MVr with DVR.
- Literature search of PubMed, EMBASE, and Cochrane databases up to October 2022.
- Primary outcome: long-term survival; Secondary outcomes: early mortality, mitral reoperation, valve events.
Main Results:
- AVR plus MVr showed a trend towards better long-term survival (80.95% at 5 years vs. 76.62% for DVR).
- AVR plus MVr significantly reduced early mortality, thromboembolic, and haemorrhagic events.
- Comparable rates of mitral reoperation and infective endocarditis were observed, except for higher reoperation in rheumatic heart disease patients.
Conclusions:
- AVR plus MVr is associated with favorable long-term survival and reduced adverse events compared to DVR in unselected patients.
- The procedure does not increase mitral reoperation or infective endocarditis risk generally.
- Rheumatic heart disease patients undergoing AVR plus MVr experienced significantly higher reoperation rates.
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