Key result
Mitral valve repair was associated with lower late mortality compared to replacement in patients with IE (HR 0.72), IMR (HR 0.82), and DMR (HR 0.73), but a higher risk of reoperation in RHD.
Why the study?
The preference for mitral valve repair over replacement lacks clinical trial evidence, and the benefits of repair may not be universal across all mitral valve disease etiologies.
Does mitral valve repair improve all-cause mortality compared to mitral valve replacement in patients with different etiologies of mitral valve disease?
Cohort (n=18,428)
Yes
Does mitral valve repair improve all-cause mortality compared to mitral valve replacement in patients with different etiologies of mitral valve disease?
Hazard Ratio: 0.8 (95% CI 0.74–0.87)
Absolute Event Rate: 31.2% vs 37.3%
p-value: p=<0.001
Mitral valve repair is associated with lower late mortality compared to replacement in patients with infective endocarditis, ischemic MR, and degenerative MR, but carries a higher risk of reoperation in patients with rheumatic heart disease.
BACKGROUND: When mitral valve (MV) surgery is indicated, repair is preferred over replacement; however, this preference is not supported by evidence from clinical trials. Furthermore, the benefits of MV repair may not be universal for all etiologies of MV disease. METHODS AND RESULTS: This study identified a total of 18,428 patients who underwent MV repair (n=4,817) or MV replacement (n=13,611) during 2001-2018 from Taiwan's National Health Insurance Research Database. These patients were classified into 4 etiologies: infective endocarditis (IE, n=2,678), rheumatic heart disease (RHD, n=4,524), ischemic mitral regurgitation (IMR, n=3,893), and degenerative mitral regurgitation (DMR, n=7,333). After propensity matching, all-cause mortality during follow-up was lower among patients receiving MV repair than among patients receiving MV replacement in the IE, IMR, and DMR groups (hazard ratio [HR]=0.72, 95% confidence interval [CI]: 0.55-0.93; HR=0.82, 95% CI: 0.73-0.92; and HR 0.73, 95% CI: 0.64-0.84, respectively). However, in the RHD group, the MV reoperation rate was higher after MV repair than after MV replacement (subdistribution HR=1.91, 95% CI: 1.02-3.55). CONCLUSIONS: In comparison with MV replacement, MV repair was associated with a lower late mortality in patients with IE, IMR, and DMR, and a higher risk of reoperation in patients with RHD.
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Lee et al. (2024) conducted a cohort in Mitral valve disease (infective endocarditis, rheumatic heart disease, ischemic mitral regurgitation, degenerative mitral regurgitation) (n=18,428). Mitral valve repair vs. Mitral valve replacement was evaluated on All-cause mortality during follow-up (HR 0.80, 95% CI 0.74-0.87, p=<0.001). Mitral valve repair was associated with lower late mortality compared to replacement in patients with IE (HR 0.72), IMR (HR 0.82), and DMR (HR 0.73), but a higher risk of reoperation in RHD.
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