Benefits of mitral valve repair over replacement in the elderly: a systematic review and meta‐analysis

Abstract

Objectives: Mitral valve (MV) repair has demonstrated excellent short-and longterm outcomes, however, its merit in the elderly population is still debated. We conducted a meta-analysis of studies that have compared the MV repair to replacement in the elderly population.Methods: A systematic literature search was conducted for any study published on MV surgery on elderly patients (≥75 years old). A pooled risk-ratio meta-analysis was done to evaluate short-term mortality, postoperative complications, surgical timings, and long-term survival rates.Results: A total of nine retrospective observational studies were included in the quantitative meta-analysis. Pooled meta-analysis showed a reduced risk of short-term mortality for the MV repair group (risk ratio [RR] = 0.41 [0.24-0.71], p-value = .005). Postoperative neurological complications were in favor of repair, although not significantly (RR = 0.49 [0.21-1.11], p-value = .07). Operative timings (cardiopulmonary bypass and crossclamp time) were not different between the groups although no data were available on the complexity of the repairs. Long-term survival rates were in favor of the repairs (pooled treatment effect of −0.47 [−0.64; −0.29], p = .005).Conclusions: MV surgery is a safe and effective procedure for the elderly. MV repair demonstrated better short-term outcomes compared to replacement. Long-term survival rates are significantly better after repair. elderly, meta-analysis, mitral valve, mitral valve repairThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Mitral valve repair for mitral regugitation in the elderly: Yes, we have to, but look at the etiologies!

“…This meta‐analysis 1 shows that patients with rheumatic MR have, correctly, a high prevalence of MVR (87%) and nobody doubts that MVR is the best solution for this etiology, irrespective of the global concept of the superiority of repair on replacement. On the other side, we know that degenerative MR can be, in expert hands, repaired in many patients (65% in this study 1 ) with good long‐term freedom from residual MR. But in patients with ischemic MR repair failure can be high in the midterm 10 and the risk of a reoperation can be often less acceptable than in younger patients.…”

“…Even if repair can be performed in presence of some specific etiologies, as degenerative MR or secondary MR, there are always cases where a replacement can be an acceptable solution compared to a repair with uncertain future, regardless of our believes and our technical ability. This meta-analysis 1 shows that patients with rheumatic MR have, correctly, a high prevalence of MVR (87%) and nobody doubts that MVR is the best solution for this etiology, irrespective of the global concept of the superiority of repair on replacement. On the other side, we know that degenerative MR can be, in expert hands, repaired in many patients (65% in this study 1 ) with good long-term freedom from residual MR.…”

“…In this issue, Di Tommaso et al 1 report a meta‐analysis of studies comparing MVr and mitral valve replacement (MVR) for mitral regurgitation (MR) in the elderly. Results support once again our previous knowledge.…”

Cardiac Surgery 2021 Reviewed

“…6). Since mitral valve replacement is associated with poorer survival than mitral valve repair, [55][56][57] this finding is important for individual assessment by the heart valve team.…”

Case report: Infective endocarditis caused by Streptococcus sinensis: The first case in mainland China and literature review

“…Surgical exploration showed scattered and small vegetations on the left ventricular surface of the anterior mitral valve without obvious valve leaf thickening, ulceration, or involvement of chordae tendineae, so mitral valve repair was performed. Several studies have shown that mitral valve repair has low mortality, fewer complications, and a better long-term prognosis than mitral valve replacement (24)(25)(26). Of these cases, only one death occurred in a 58-yearold man who refused surgery and died of multiple cerebral infarctions several days after admission, suggesting that timely treatment is of great importance in the acute phase of infection.…”