Repair versus Replacement for the Surgical Correction of Degenerative Mitral Regurgitation: A Meta-analysis

Jun Chul Jeong, Myoung-jin Jang, Ho Young Hwang

Seoul National University College of Medicine, Seoul, Korea (South)

Date, time and location: 2018.05.26 13:30, Congress Hall, 2F–B

Abstract

Objectives: Although current guidelines recommend mitral valve repair (MVr) for patients with mitral regurgitation (MR), it is unclear if it is reasonable to recommend MVr even in elderly patients with degenerative MR.This study was conducted to compare the results of MVr with those of mitral valve replacement (MVR) in order to find an optimal treatment option according to the patients age.

Methods:A literature search of 5 databases was performed.The primary outcome was all-cause mortality. Secondary outcomes were early mortality, mitral reoperation and valve-related events. Subgroup analyses were performed according to the proportion of elderly patients. Publication bias was explored using the funnel plot and Egger's test.

Results:Fourteen retrospective studies involving 4,644 patients (MVr group=3,275 patients; MVR group=1,369 patients)were included. A pooled analysis showed that the risk of all-cause mortality was significantly higher in the MVR group than in the MVr group in overall studies and in studies showing adjusted results(hazard ratio[95% confidence interval]=1.59 [1.26-2.00] and 1.64 [1.43-1.88], respectively). This benefit remained significant when a pooled analysis was performed in 4 studies (n=577) in which adjusted results were shown exclusively in elderly patients at least 70 years or more (hazard ratio[95% confidence interval]=1.72 [1.27-2.33]. No publication bias was identified for the primary and secondary outcomes.

Conclusions:The present meta-analysis indicates that MVr is beneficial compared to MVR in terms of all-cause mortality even in elderly patient population.