Early and late mortality after repair or replacement in mitral valve prolapse and functional ischemic mitral regurgitation: A systematic review and meta-analysis of observational studies

Background The 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. Methods We 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. Result A 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. Conclusion Mitral 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.

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Mitral valve replacement therapy causes higher 30-day postoperative mortality than mitral valvuloplasty in patients with severe ischemic mitral regurgitation: A meta-analysis of 12 studies

International Journal of Cardiology ◽

10.1016/j.ijcard.2015.03.170 ◽

2015 ◽

Vol 185 ◽

pp. 304-307 ◽

Cited By ~ 7

Author(s):

Jiayang Wang ◽

Chengxiong Gu ◽

Mingxin Gao ◽

Wenyuan Yu ◽

Yang Yu

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Replacement Therapy ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Meta Analysis ◽

Postoperative Mortality ◽

Ischemic Mitral Regurgitation ◽

Mitral Valvuloplasty

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Tricuspid valve intervention at the time of mitral valve surgery: a meta-analysis

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz036 ◽

2019 ◽

Vol 29 (2) ◽

pp. 193-200 ◽

Cited By ~ 3

Author(s):

Derrick Y Tam ◽

Andrew Tran ◽

Amine Mazine ◽

Gilbert H L Tang ◽

Mario F L Gaudino ◽

...

Keyword(s):

Mitral Valve ◽

Tricuspid Valve ◽

Observational Studies ◽

Meta Analysis ◽

Statistical Significance ◽

Pacemaker Implantation ◽

Perioperative Period ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Late Mortality

Abstract OBJECTIVES The surgical management of tricuspid regurgitation (TR) at the time of mitral valve surgery remains controversial. Our objectives were to determine the safety and efficacy of tricuspid valve (TV) repair during mitral valve surgery in a meta-analysis. METHODS MEDLINE and EMBASE were searched from 1946 to 2017 for all studies comparing TV repair to no intervention at the time of mitral valve surgery on early and late mortality and late TR. A random-effects meta-analysis of all outcomes was performed. RESULTS One thousand four hundred and seventeen studies were retrieved and a total of 17 studies [2 randomized clinical trial (n = 211), 11 adjusted observational studies (n = 3848) and 4 unadjusted observational studies (n = 67 010)] that compared TV repair (n = 11 787) to no intervention (n = 56 027) at a mean follow-up of 6.0 ± 0.64 years were included. There was no difference in 30-day/in-hospital mortality between repair and no repair [risk ratio (RR) 1.19, 95% confidence interval (95% CI) 0.70–2.02; P = 0.52]. The incidence of new permanent pacemaker implantation was higher in the TV repair group (RR 2.73, 95% CI 2.57–2.89; P < 0.01). TV repair was protective against late moderate or greater TR [incident rate ratio (IRR) 0.28, 95% CI 0.17–0.47; P < 0.01] and severe TR (IRR 0.38, 95% CI 0.17–0.84). There was a numerically lower rate of late TV reoperation (IRR 0.39, 95% CI 0.12–1.25; P = 0.11) that did not reach statistical significance. Overall, there was no difference in late mortality between the 2 treatments (IRR 0.87, 95% CI 0.63–1.24; P = 0.43). CONCLUSIONS TV repair appears safe in the perioperative period and may reduce future recurrent TR without any survival benefit.

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Mitral valve prolapse and sudden cardiac death: a systematic review and meta-analysis

Heart ◽

10.1136/heartjnl-2017-312932 ◽

2018 ◽

Vol 105 (2) ◽

pp. 144-151 ◽

Cited By ~ 22

Author(s):

Chrishan J Nalliah ◽

Rajiv Mahajan ◽

Adrian D Elliott ◽

Haris Haqqani ◽

Dennis H Lau ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Sudden Cardiac Death ◽

Mitral Valve ◽

Mitral Valve Prolapse ◽

Cardiac Death ◽

Meta Analysis ◽

Ventricular Ectopy ◽

T Wave ◽

Ventricular Fibrosis

ObjectivesMitral valve prolapse (MVP) is commonly observed as a benign finding. However, the literature suggests that it may be associated with sudden cardiac death (SCD). We performed a meta-analysis and systematic review to determine the: (1) prevalence of MVP in the general population; (2) prevalence of MVP in all SCD and unexplained SCD; (3) incidence of SCD in MVP and (4) risk factors for SCD.MethodsThe English medical literature was searched for: (1) MVP community prevalence; (2) MVP prevalence in SCD cohorts; (3) incidence SCD in MVP and (4) SCD risk factors in MVP. Thirty-four studies were identified for inclusion. This study was registered with PROSPERO (CRD42018089502).ResultsThe prevalence of MVP was 1.2% (95% CI 0.5 to 2.0) in community populations. Among SCD victims, the cause of death remained undetermined in 22.1% (95% CI 13.4 to 30.7); of these, MVP was observed in 11.7% (95% CI 5.8 to 19.1). The incidence of SCD in the MVP population was 0.14% (95% CI 0.1 to 0.3) per year. Potential risk factors for SCD include bileaflet prolapse, ventricular fibrosis complex ventricular ectopy and ST-T wave abnormalities.ConclusionThe high prevalence of MVP in cohorts of unexplained SCD despite low population prevalence provides indirect evidence of an association of MVP with SCD. The absolute number of people exposed to the risk of SCD is significant, although the incidence of life-threatening arrhythmic events in the general MVP population remains low. High-risk features include bileaflet prolapse, ventricular fibrosis, ST-T wave abnormalities and frequent complex ventricular ectopy.Trial registrationPROSPERO (CRD42018089502).

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Percutaneous Mitral Valve Repair versus Optimal Medical Therapy in Patients with Functional Mitral Regurgitation: A Systematic Review and Meta-Analysis

Journal of Interventional Cardiology ◽

10.1155/2019/2753146 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Muhammad Uzair Lodhi ◽

Muhammad Shariq Usman ◽

Tariq Jamal Siddiqi ◽

Muhammad Shahzeb Khan ◽

Muhammad Arbaz Arshad Khan ◽

...

Keyword(s):

Systematic Review ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Medical Therapy ◽

Cardiovascular Mortality ◽

Meta Analysis ◽

Functional Mitral Regurgitation ◽

Valve Repair ◽

Percutaneous Mitral Valve Repair

Objectives. To compare percutaneous mitral valve repair (PMVR) with optimal medical therapy (OMT) in patients with heart failure (HF) and severe functional mitral regurgitation (FMR). Background. Many patients with HF and FMR are not suitable for surgical valve replacement and remain symptomatic despite maximal OMT. PMVR has recently emerged as an alternative solution. Methods. We performed a systematic review and a meta-analysis to address this question. Cochrane CENTRAL, MEDLINE, and Scopus were searched for randomized (RCT) and nonrandomized studies comparing PMVR with OMT in patients with HF and FMR. Primary endpoint was all-cause midterm mortality (at 1 and 2 years). Secondary endpoints were 30-day mortality and cardiovascular mortality and HF hospitalizations, at maximum follow-up. Studies including mixed cohort of degenerative and functional MR were allowed initially but were excluded in a secondary sensitivity analysis for each of the study’s end points. This meta-analysis was performed following the publication of two RCTs (MITRA-FR and COAPT). Results. Eight studies (six observational, two RCTs) comprising 3,009 patients were included in the meta-analysis. In comparison with OMT, PMVR significantly reduced 1-year mortality (RR: 0.70 [0.56, 0.87]; p=0.002; I2=47.6%), 2-year mortality (RR: 0.63 [0.55, 0.73]; p<0.001; I2=0%), and cardiovascular mortality (RR: 0.32 [0.23, 0.44]; p<0.001; I2=0%). No significant difference between PMVR+OMT and OMT was noted in HF hospitalization (HR: 0.69 [0.40, 1.20]; p=0.19; I2=85%) and 30-day mortality (RR: 1.13 [0.68, 1.87]; p=0.16; I2=0%). Conclusions. In comparison with OMT, PMVR significantly reduces 1-year mortality, 2-year mortality, and cardiovascular mortality in patients with HF and severe MR.

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