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August 1, 2018MedicineOpen Access

Repair or replacement for severe ischemic mitral regurgitation

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Key result

Mitral valve repair was associated with a lower perioperative mortality (OR 0.61) but a higher recurrence of mitral regurgitation (OR 4.09) compared with replacement for severe ischemic mitral regurgitation.

Why the study?

Does mitral valve repair reduce perioperative mortality and improve long-term survival compared to mitral valve replacement in patients with severe ischemic mitral regurgitation?

Population

13 studies pooling 1993 patients with severe ischemic mitral regurgitation (IMR)

Comparison

Mitral valve repair (MVP) vs Mitral valve replacement (MVR)

Design

Meta-analysis

Authors

XWXinxin WangBZBo ZhangJZJian Zhang

Discussion

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Member takes

Overview

Supports repair to lower perioperative mortality in severe ischemic MR; leaves optimal long-term strategy open given higher recurrence.

Study Design

Type

Meta-Analysis (n=1,993)

Structured PICO

Does mitral valve repair reduce perioperative mortality and improve long-term survival compared to mitral valve replacement in patients with severe ischemic mitral regurgitation?

P
Population
1,993 patients with severe ischemic mitral regurgitation included in a meta-analysis of 13 studies comparing mitral valve repair versus replacement.
I
Intervention
Mitral valve repair (MVP)
C
Comparator
Mitral valve replacement (MVR)
O
Outcome
Perioperative mortality and long-term survivalhard clinical

Main Result

Odds Ratio: 0.61 (95% CI 0.43–0.87)

p-value: p=<.05

In patients with severe ischemic mitral regurgitation, mitral valve repair is associated with lower perioperative mortality but higher MR recurrence compared to replacement, with no significant difference in long-term survival.

Limitations

  • Inclusion of observational, retrospective studies with inherent biases of study design
  • Follow-up data on changes in NYHA class, LVEF, and left ventricle remodeling were not provided in most studies
  • Confounding factors such as age, EF, SVA preservation techniques, and concomitant CABG were not adjusted in the studies

Cite This Study

Wang et al. (2018) conducted a meta-analysis in Severe ischemic mitral regurgitation (n=1,993). Mitral valve repair vs. Mitral valve replacement was evaluated on Perioperative mortality (OR 0.61, 95% CI 0.43-0.87, p=<.05). Mitral valve repair was associated with a lower perioperative mortality (OR 0.61) but a higher recurrence of mitral regurgitation (OR 4.09) compared with replacement for severe ischemic mitral regurgitation.

synapsesocial.com/papers/6a95b9453dfa00dc4d54fa09https://doi.org/10.1097/md.0000000000011546
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Is valve repair preferable to valve replacement in ischaemic mitral regurgitation? A systematic review and meta-analysis2016 · 34 citations
  2. 2The effect of pathophysiology on the surgical treatment of ischemic mitral regurgitation: operative and late risks of repair versus replacement1995 · 206 citations
  3. 3Mitral valve repair is superior to valve replacement for the early preservation of cardiac function: Relation of ventricular geometry to function1996 · 58 citations
  4. 4Surgical Revascularization Is Associated With Maximal Survival in Patients With Ischemic Mitral Regurgitation2014 · 99 citations
  5. 5A comparison of mitral valve reconstruction with mitral valve replacement: Intermediate-term results1989 · 171 citations