title: Is valve repair preferable to valve replacement in ischaemic mitral regurgitation? A systematic review and meta-analysis.
abstract: Ischaemic mitral regurgitation (MR) is associated with poor survival. The favoured surgical option remains debatable. Our aim was to perform a meta-analysis to compare the outcomes of mitral valve repair (MVRp) with replacement (MVR). A literature search was conducted in PubMed, Medline and Ovid using the terms 'ischaemic mitral regurgitation', 'repair' and 'replacement'. The primary outcome measure was 30-day survival. The secondary outcome measures were MR recurrence and reoperation. Out of 310 articles, 18 fulfilled the inclusion criteria. A total of 3978 patients were included: 2563 (64%) MVRp cases and 1415 (36%) MVR cases. Operative techniques included annuloplasty for MVRp and subvalvular apparatus-sparing MVR techniques. Thirty-day mortality was lower after MVRp compared with MVR [OR 0.42; (95% CI 0.33-0.54; P = 0.0001)]. There was no difference in long-term survival ranging 1-5 years (HR 0.85, 95% CI 0.65-1.12). Recurrence of MR was significantly higher in the MVRp group (OR 4.26, 95% CI 2.52-7.22), as was the rate of reoperation (OR 2.03, 95% CI 1.49-2.77). Although MVR for ischaemic MR has a higher 30-day mortality rate compared with MVRp, MVRp is associated with the higher rate of MR recurrence and the need for reoperation. MVR remains an attractive option for ischaemic MR.
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals of Leicester, Leicester, UK mybsalmasi86@gmail.com.
authors.forename: Mohammad Yousuf
authors.initials: MY
authors.lastname: Salmasi
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, UK.
authors.forename: Metesh
authors.initials: M
authors.lastname: Acharya
authors.affiliation: Department of Cardiothoracic Surgery, University Hospitals of Leicester, Leicester, UK.
authors.forename: Nada
authors.initials: N
authors.lastname: Humayun
authors.affiliation: Department of Surgery, Bradford Hospitals Trust, Bradford, UK.
authors.forename: Dinnish
authors.initials: D
authors.lastname: Baskaran
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hubbard
authors.affiliation: Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK.
authors.forename: Hunaid
authors.initials: H
authors.lastname: Vohra
mesh_terms: D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality*; D006801:Humans; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000379:methods / Q000401:mortality*; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications* / Q000601:surgery; D064887:Observational Studies as Topic; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Ischaemic mitral regurgitation; Long-term survival; Meta-analysis; Mitral valve repair; Mitral valve replacement