Key result
Mitral valve repair showed a non-significant trend toward lower perioperative mortality compared to replacement (OR 0.66; 95% CI 0.41-1.07; p=0.09), but had significantly higher MR recurrence.
Why the study?
Ischemic mitral regurgitation is a serious consequence of coronary artery disease, but the choice of the optimal surgical strategy remains debatable.
Does mitral valve repair improve mortality or reduce recurrence compared to mitral valve replacement in patients with severe ischemic mitral regurgitation?
Meta-Analysis
Does mitral valve repair improve mortality or reduce recurrence compared to mitral valve replacement in patients with severe ischemic mitral regurgitation?
Odds Ratio: 0.66 (95% CI 0.41–1.07)
p-value: p=0.09
In patients with severe ischemic mitral regurgitation, mitral valve repair is associated with a significantly higher risk of MR recurrence compared to replacement, without a statistically significant reduction in perioperative mortality.
Repair may increase recurrence without clear mortality benefit in ischemic MR; leaves open optimal strategy pending RCTs.
BACKGROUND AND AIM: Ischemic mitral regurgitation (IMR) is a serious consequence of coronary artery disease. The choice of the optimal surgical strategy remains debatable. The aim of the present meta-analysis is to compare the outcomes of mitral valve repair (RPR) versus replacement (RPL) regarding perioperative mortality, overall mortality, reoperation, recurrence of MR, and reverse remodeling after surgery. METHODS: Electronic searches were performed using the searchable databases of Google Scholar, Pubmed, and Embase, and the search terms mitral valve, IMR, RPR, RPL, and coronary artery bypass grafting. The main outcomes of interest are perioperative mortality, overall mortality, reoperation, recurrence of MR, and reverse remodeling after surgery. Perioperative mortality was defined as death during the surgery or within 30 days after the operation. RESULTS: There was a trend towards better perioperative survival in the RPR arm. However, the difference fell short of statistical significance [odds ratio (OR) (95% confidence interval [CI]): 0.66 (0.41-1.07), p = 0.09]. Patients submitted to RPR experienced a significantly higher MR recurrence rate when compared with their counterparts submitted to RPL [OR (95% CI): 16.8 (5.07-55.7, p = 0.00001)]. CONCLUSION: There is a trend towards lower perioperative mortality in RPR in comparison to RPL. On the other hand, RPL was associated with significantly lower recurrence rates.
No takes yet. Share an insight, caveat, or question.
Gamal et al. (2022) conducted a meta-analysis in Severe ischemic mitral regurgitation. Mitral valve repair vs. Mitral valve replacement was evaluated on Perioperative mortality (OR 0.66, 95% CI 0.41-1.07, p=0.09). Mitral valve repair showed a non-significant trend toward lower perioperative mortality compared to replacement (OR 0.66; 95% CI 0.41-1.07; p=0.09), but had significantly higher MR recurrence.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: