title: Comparison of Outcomes following Mitral Valve Repair versus Replacement for Chronic Ischemic Mitral Regurgitation: A Meta-Analysis.
abstract: BackgroundThe selection of mitral valve surgery, including mitral valve repair and mitral valve replacement, is still an important dilemma for patients with chronic ischemic mitral regurgitation. We carry out a meta-analysis to evaluate the effectiveness and safety of mitral valve repair versus replacement for ischemic mitral regurgitation.MethodsWe searched PubMed, Embase, the Cochrane Library, and Web of Science to identify studies from their inception to July 2015. A meta-analysis was performed using RevMan 5.3 software (Cochrane Collaboration, Oxford, United Kingdom). A random-effect model was used and sensitivity analysis was performed on studies reporting on operation after 2000, high-quality studies, and those studies reporting on more than 150 patients.ResultA total of 2,324 patients were identified from 10 retrospective studies. Mitral valve repair was associated with a trend toward lower operative mortality (odds ratio [OR] = 0.45; 95% confidence interval [CI]: 0.31-0.65;p< 0.0001) and higher recurrence of mitral regurgitation (OR = 5.89; 95% CI: 3.34-10.39;p< 0.00001). Five-year survival rate was similar between the two groups (OR = 1.20; 95% CI: 0.88-1.65;p= 0.25). No differences in reoperation, the incidence of acute renal failure and acute respiratory failure, the length of ICU stay, and the length of hospital stay were found.ConclusionMitral valve repair was associated with lower operative mortality but a higher recurrence of mitral regurgitation compared with mitral valve replacement. Owing to the limited quantity and quality of the included studies, this conclusion still needs to be further confirmed by conducting more high-quality, multicenter randomized controlled trials with large sample size.
authors.affiliation: Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Deng
authors.initials: D
authors.lastname: Yun-Dan
authors.affiliation: Department of Gynecology and Obstetrics, The First Hospital of Lanzhou University, Lanzhou, Gansu, China.
authors.forename: Du
authors.initials: D
authors.lastname: Wen-Jing
authors.affiliation: Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Xi-Jun
mesh_terms: D002908:Chronic Disease; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome