A meta-analysis of late outcomes of mitral valve repair in patients with rheumatic heart disease

Abstract

Background: Rheumatic heart disease (RHD) is a predominant health concern in developing countries.The aim of this meta-analysis was to evaluate the outcomes of mitral valve (MV) repair in patients with RHD, and identify predictors that may postoperatively affect treatment outcome. Methods: A meta-analysis of eligible studies assessing patients undergoing MV repair with RHD and reporting the outcomes of MV repair, including 30-day mortality and long-term follow-up survival, MV reoperation rate and postoperative adverse events. Relevant English articles were searched up to 1 March, 2017 in Web of Science, PubMed, Google Scholar, Cochrane Library, EmBase, Elsevier, and Science Direct.Selected studies should meet all inclusion criteria, and underwent data extraction. Results: A total of ten studies with 2,770 patients met all inclusion criteria, and were selected for assessment. Pooled analysis showed that 30-day mortality in patients with rheumatic MV disease after MV repair surgery was 1.9%, 95% confidence interval (CI) (0.8-2.9%); long-term survival was 97.3%, 95% CI (95.9-98.6%), and a freedom from reoperation rate of 93.6%, 95% CI (91.4-95.9%) was obtained; freedom from adverse events was 97.5%, 95% CI (95.2-99.8%). Conclusions:The outcome of rheumatic MV repair is outstanding in terms of low early mortality, high long-term survival and freedom from valve-related complications, which may be very common in patients after rheumatic MV replacement; meanwhile, MV reoperation rate after initial surgery is acceptable. Surgeons may try to repair MV in RHD when it is feasibleKeywords: Rheumatic heart disease (RHD); mitral valve (MV) repair; outcomes; meta-analysis J Thorac Dis 2017;9(11):4366-4375 jtd.amegroups.com feasibility of MV repair for RHD patients is extremely low. However, other studies (3,4) believed that MV replacement may not be the most optimal surgical treatment for such patients, demonstrating the advantages of MV repair over replacement in terms of low rate of early mortality, better late survival, preservation of left ventricular function, and reduced anticoagulant-related complications. Here, we systematically reviewed published literature and performed a meta-analysis which assessed the outcomes of MV repair in patients with RHD, exploring predictive factors that may postoperatively affect treatment outcome. Methods Literature searchWeb of Science, PubMed, Cochrane Library, Google Scholar, EmBase, Elsevier, and ScienceDirect were independently searched by two authors (JT Fu, MS Popal) for potentially relevant studies which analyzed the outcomes of MV repair for rheumatic MV disease, up to 1 March, 2017. The following key terms were used either alone or in combination: "rheumatic heart disease", "RHD", "mitral valve repair", "MVP", "mitral valve reconstruction", and "mitral valve surgery". Some references in relevant studies were hand searched for additional articles which could not be identified by the advanced search. Selection criteriaThe inclusion criteria were: (I) directly analysis of MV repair...

A predictor for mitral valve repair in patient with rheumatic heart disease: the bending angle of anterior mitral leaflet

“…WS is the most effective and extensively used evaluation system for PMBV, patients which scored >11 point tend to be suboptimal outcome of PMBV (8) and undergoing open valve surgery is more reasonable. However, outcomes of PMBV in Patients which scored 9-11 cannot be guaranteed (8), in-patient mortality occurred in patients in the WS gray zone (9-11) was 8.3% (19), which was significantly higher than the 30-day mortality after rheumatic MV repair that we have reported was only 1.9% (20). Valve tear and acute severe MR following PMBV are not uncommon complications for PMBV, in-patient mortality of emergency surgery for these complications can achieve 12% (21) if we insist to carry out the intervention therapy when result of PMBV is uncertain, in these cases rheumatic MV repair may be the preferred surgical option.…”

Infective endocarditis as a morbidity predictor in patients who underwent mitral valve surgery

“…15 Both replacement and repair surgery in mitral valve are effective for MV disease. 20 Although there is superiority of MV repair over MV replacement for degenerative valve, patients with rheumatic disease because of IE may reduce the durability of MV repair. 20 The increase of pulmonary artery pressure often occurs in both mitral stenosis and mitral regurgitation, and the presence of pulmonary arterial hypertension (PAH) in mitral valve disease is also key to determine the best treatment.…”

“…20 Although there is superiority of MV repair over MV replacement for degenerative valve, patients with rheumatic disease because of IE may reduce the durability of MV repair. 20 The increase of pulmonary artery pressure often occurs in both mitral stenosis and mitral regurgitation, and the presence of pulmonary arterial hypertension (PAH) in mitral valve disease is also key to determine the best treatment. 21,22 PAH can be occurred due to an increase in left atrial pressure which can be developed into pulmonary venous hypertension and subsequent pulmonary arterial hypertension.…”

Long-term outcomes of rheumatic mitral valve repair: Is it worthwhile to do it?

“…However, valve repair techniques are frequently used with excellent short- and midterm outcomes in many centers. 1 , 2 The aim of this study was to evaluate the long-term outcomes of mitral valve repair in rheumatic patients, in terms of survival rate, durability of the procedure, and reoperation rate.…”