Rheumatic mitral valve disease: Comparative outcomes of repair versus replacement.

Area of Science:

• Cardiovascular Surgery
• Rheumatic Heart Disease
• Valvular Heart Disease

Background:

• Rheumatic mitral valve disease is a significant cause of death globally.
• Surgical intervention, including mitral valve repair/valvuloplasty (MVP) and mitral valve replacement (MVR), is crucial for advanced stages.
• Existing comparative evidence on long-term outcomes of MVP versus MVR is inconsistent.

Purpose of the Study:

• To systematically review and synthesize evidence comparing the long-term outcomes of mitral valve repair versus replacement in rheumatic mitral valve disease.
• To provide a comprehensive overview of current scientific literature on this topic.

Main Methods:

• Systematic review of studies published between 2016 and April 2025.
• Searches conducted in PubMed, Virtual Health Library, and Cochrane databases.
• Inclusion of adult patients with a minimum five-year follow-up, totaling 36,136 patients across nine studies.

Main Results:

• Mitral valve repair demonstrated lower early mortality (0.96% vs. 2.2%), reduced thromboembolic and hemorrhagic events, and better left ventricular function preservation.
• Mitral valve replacement showed significantly lower reoperation rates (<2% vs. 7-19% for repair).
• Quality of life favored repair, but replacement was preferred for extensive calcification, fibrosis, or severe stenosis.

Conclusions:

• Mitral valve repair, when anatomically feasible, yields superior early outcomes and fewer long-term complications compared to replacement.
• Individualized surgical decisions are essential, considering valve anatomy, patient factors, and surgeon expertise.
• Replacement remains a viable option for specific complex cases of rheumatic mitral valve disease.