Background
Rheumatic heart disease remains one of the leading causes of heart valve disease worldwide
despite being a preventable condition. Mitral valve repair is superior to replacement
in severe degenerative mitral valve disease, however its role in rheumatic valve disease
remains controversial. This meta-analysis compared mitral valve repair and replacement
in rheumatic heart disease.
Methods
Medline, EMBASE, Cochrane and Scopus were searched from January 1980 to June 2016
for original studies reporting outcomes of both mitral valve repair and replacement
in rheumatic heart disease in adults, children or both. Two (2) authors independently
assessed studies for inclusion, followed by data extraction and analysis.
Results
The search yielded 930 articles, with 98 full-texts reviewed after initial screening
and 13 studies subsequently included for analysis, totalling 2,410 mitral valve repairs
and 3,598 replacements. Pooled rates and odds ratio (95% confidence interval) for
operative mortality of repair versus replacement was 3.2% versus 4.3%, 0.68 (0.50–0.92;
p=0.01). Pooled odds ratios (95% confidence interval) were for long-term mortality
0.41 (0.30–0.56; p<0.001); reoperation 3.02 (1.72–5.31; p<0.001); and bleeding 0.26
(0.11–0.63; p=0.003). There was a trend towards lower thrombo-embolism 0.42 (0.17–1.03;
p=0.06), and no significant difference in endocarditis (p=0.76), during follow-up.
Conclusion
Mitral valve repair is associated with reduction in operative and long-term mortality
and bleeding, so is recommended in rheumatic mitral valve disease where feasible,
but it does entail a higher rate of reoperation during follow-up.
Keywords
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Article info
Publication history
Published online: February 01, 2022
Accepted:
November 3,
2021
Received in revised form:
March 17,
2020
Received:
September 24,
2018
Identification
Copyright
© 2021 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
