Abstract 12788: Outcomes of Concomitant Mitral Valve Repair Compared to Replacement in Patients Undergoing Aortic Valve Surgery: A Meta-analysis of Observational Studies
Introduction Long term superiority of mitral valve (MV) repair compared to MV replacement is well established in degenerative MV disease. In rheumatic heart disease (RHD), its benefits are unclear & is often performed in conjunction with aortic valve replacement (AVR). Hence we performed a systematic review & meta analysis comparing outcomes of MV repair Vs replacement in patients undergoing AVR.
Methods PUBMED, COCHRANE & Web of Science databases were searched through May 15th 2012 for English language studies comparing outcomes of MV repair Vs replacement in patients undergoing AVR. Analysis was performed using random effects model (MOOSE recommendation). Data of selected studies was extracted. Study quality, publication bias & heterogeneity were assessed.
Results Total of 1129 abstracts / titles were screened. Of these, 19 were selected for full text review & 7 studies (3671 patients) were included in analysis; 1160 underwent MV repair & 2511 underwent replacement. Late outcome data was available in 6 studies (cumulative follow up: 15654 patient years). Early (in hospital & ≤ 30 days after surgery) & late mortality and thromboembolism (including valve thrombosis) were significantly lower in MV repair group with odds ratio of 0.64 (95% CI 0.48-0.85 p=0.002), 0.63 (95% CI 0.47-0.83 p=0.001) & 0.56 (95% CI 0.34-0.92 p=0.023) respectively. MV reoperation rate was more frequent in repair group (OR 2.85, 95% CI 1.01-8.06 p=0.047). In a sensitivity analysis of exclusively RHD patients, mortality benefit of MV repair was abolished (early OR 0.91, 95% CI 0.42, 1.97 p=0.82; late OR 0.66, 95% CI 0.35, 1.25 p=0.20) & the risk for MV reoperation was higher (OR 6.17, 95% CI 2.4, 15.8 p>0.0001).
Conclusion In patients undergoing concomitant AV & MV surgery, MV repair is associated with improved perioperative & long term survival, though this benefit is not seen in RHD patients. However, MV reoperation remains high in repair group irrespective of the etiology of valve disease
- © 2012 by American Heart Association, Inc.