To repair or to replace in mitral valve infective endocarditis? an updated meta-analysis

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.

Infective endocarditis of mitral valve, valve replacement or repair?- a meta-analysis of 10,965 patients

Background

Being characterized by high mortality and recurrence rates, native mitral valve infective endocarditis (IE) constitutes a burden on both patients and surgeons from its poor prognosis and debatable interventions. Mitral valve repair (MVRr) and mitral valve replacement (MVRp) are two main surgical methods. Nevertheless, which of them carries an outweigh benefit over the other is still controversial. Thus, in our meta-analysis we aimed to further investigate the efficacy of each technique on both short term and long-term outcomes.

Methods

Our search strategy was applied on several databases including the PubMed, Scopus, Web of science, and Cochrane literature databases to compare MVP and MVR, with data extracted for baseline characteristics, mortality, survival, recurrent endocarditis, and valve reoperation. Risk and hazard ratio (RR and HR) and 95% confidence interval (CI) were pooled and analyzed using RevMan 5.0.

Results

A total of 22 relevant publications with a total population of 10,965 patients, with 3,557 patients having undergone MVRr and 7,408 patients having undergone MVRp, respectively, were analyzed. Patients who underwent MVP may benefit from a lower risk of early mortality (RR 0.44; 95% CI, 0.38–0.51; p&lt;0.00001; I2=0%), a higher long-term survival rate (HR 0.56; 95% CI, 0.36–0.76; p&lt;0.001; I2=0%), and a lower risk of recurrence (RR 0.66; 95% CI, 0.40–0.93; p=0.05; I2=0%). Although the risk of reoperation was observed lower for MVRr, it was not statistically significant (RR, 0.86; 95% CI, 0.36–1.36; p=0.76; I2=37%).

Conclusion

Our results suggests that MVRr showed superiority in the terms of in hospital mortality and long-term survival. Furthermore, it has lower risk of recurrence and valve reoperation. Therefore, MVRr is an appropriate as a primary treatment choice and should be considered whenever possible in most IE patients.

Conclusion

Our results suggests that MVRr showed superiority in the terms of in hospital mortality and long-term survival. Furthermore, it has lower risk of recurrence and valve reoperation. Therefore, MVRr is an appropriate as a primary treatment choice and should be considered whenever possible in most IE patients.

Funding Acknowledgement

Type of funding sources: None.