Mitral valve repair versus replacement in elderly patients: a systematic review and meta-analysis

Abstract

Background: Although mitral valve repair (MVP) is generally accepted as the standard treatment for mitral valve disease, in older patients, there is increasing debate about whether MVP is superior to mitral valve replacement (MVR). We, therefore, performed a meta-analysis to compare MVP vs. MVR in the elderly population. 0.56-0.86). In addition, our study also demonstrated improved 1-year (RR: 1.16, 95% CI: 1.08-1.24) and 5-year (RR: 1.26, 95% CI: 1.13-1.41) survival rates following MVP. There was no difference in reoperations between these two surgery approaches. Conclusions:The present meta-analysis indicates that elderly patients who receive MVP have better early and late outcomes than those undergoing MVR. MVP may be the preferred strategy for mitral valve surgery in the elderly population.

Heart valve disease in elderly

“…Included in a meta-analysis by Shang et al[67] were seven observational clinical studies published after 2000 comparing MVP and MVR in the elderly (aged 70 years or older). Overall, 1809 patients were considered.…”

Surgical Treatment of Degenerative Mitral Valve Regurgitation in the Elderly: Comparison of Early and Long-Term Outcomes Using Propensity Score Matching Analysis

“…However, the feasibility and efficacy of MV repair in the elderly population is still debated. Although some retrospective observational studies and meta-analyses have suggested that MV repair might have favorable results in early and long-term outcomes even in the elderly population [3–10], data obtained from administrative American databases showed a low rate of MV repair (<50%) in those older than 65 years [13,14]. Some operators, especially young surgeons, still considered older patients to be poor surgical candidates for MV repair for multiple reasons: (1) MV repair requires longer CPB and ischemic times, which can affect early and long-term clinical outcomes; (2) elderly patients tend to have a more friable or calcified leaflet and annulus, making repair technically more difficult, increasing the possibility of failure and reoperation; and (3) the shorter life expectancy of elderly patients may decrease the benefit of MV repair over MV replacement [5,8,9,15].…”

“…Current European and American guidelines recommend mitral valve (MV) repair as the treatment of choice for primary degenerative mitral regurgitation (MR) in the general population [1,2]. However, controversy exists regarding whether MV repair provides the same advantages as MV replacement in terms of operative mortality, long-term survival, and valve-related complications in the elderly population [3–10]. The aim of this study was to compare the early and long-term clinical outcomes of MV repair and MV replacement in elderly patients.…”

Dependence of mechanical properties of mitral valve annuloplasty rings on annealing modes

“…Подобные состояния требуют коррекции, как первопричины -ишемии, методами реваскуляризации миокарда, так и непосредственно морфофункциональных нарушений работы митрального клапана -протезированием или аннулопластикой [4]. Современные публикации и метаанализы крупных исследований, сравнивающие протезирование и реконструкцию митрального клапана, не могут однозначно рекомендовать тот или иной подход [5][6][7]. В целом большинство подобных работ содержат вывод об отсутствии значимых различий в выживаемости, частоте летальных исходов, ассоциированных с вмешательством, или частоте серьезных неблагоприятных сердечных или цереброваскулярных событий, акцентируя внимание на преимуществах лишь для отдельных групп или по отдельным показателям [6,7].…”

“…Современные публикации и метаанализы крупных исследований, сравнивающие протезирование и реконструкцию митрального клапана, не могут однозначно рекомендовать тот или иной подход [5][6][7]. В целом большинство подобных работ содержат вывод об отсутствии значимых различий в выживаемости, частоте летальных исходов, ассоциированных с вмешательством, или частоте серьезных неблагоприятных сердечных или цереброваскулярных событий, акцентируя внимание на преимуществах лишь для отдельных групп или по отдельным показателям [6,7]. Таким образом, выбор оптимальной хирургической тактики для коррекции тяжелой ИМР в рутинной практике зависит от ряда клинических и субъективных показателей.…”