Valve replacement or repair in native mitral valve infective endocarditis—Which is better? A meta‐analysis and systematic review

Background Native mitral valve infective endocarditis (IE) plagues patients and surgeons alike because of its high mortality and recurrence rates as well as poor prognosis. Mitral valve repair (MVP) and mitral valve replacement (MVR) are two main surgical methods. However, the question of which benefits patients more remains controversial. Thus, we conducted a meta-analysis to systematically review the two approaches, focusing on the early survival rate and long-term outcomes. Methods A meta-analysis and systematic review were conducted using studies sourced from the PubMed, Embase, and Cochrane literature databases to compare MVP and MVR, with data extracted for baseline characteristics, mortality, survival, recurrent endocarditis, and valve reoperation. Risk ratio (RR) or hazard ratio (HR) values were calculated, and publication bias was tested. Results A total of 17 relevant publications with a total population of 3759 patients, with 1180 patients having undergone MVP and 2579 patients having undergone MVR, respectively, were analyzed. Patients who underwent MVP may benefit from a lower risk of early mortality (RR, 0.51; 95% confidence interval CI, 0.39–0.66; p < .00001), a higher long-term survival rate (HR, 0.69; 95% CI, 0.58–0.81; p < .001; I2 = 0%), and a lower risk of recurrence (RR, 0.66; 95% CI, 0.40–1.09; p = .10; I2 = 0%). However, a similar risk of reoperation was observed for both groups (RR, 1.02; 95% CI, 0.36–2.91; p = .96; I2 = 43%). Conclusion This meta-analysis suggests that MVP may lead to better outcomes compared to MVR. Among patients with mitral valve IE, MVP can reduce in-hospital mortality, improve long-term survival, and has a lower risk of recurrent endocarditis. As a result, MVP may be suitable as a primary treatment choice and should be considered whenever possible in most IE patients.