scholarly journals Outcome After Mitral Valve Repair Or Replacement For Non-Ischemic Mitral Regurgitation: A System Review And Meta-Analysis

2021 ◽  
Author(s):  
Qianqian Fan ◽  
Xiaoguang Li ◽  
Guilan Cao ◽  
Puliang Yu ◽  
Fengxiao Zhang
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Cochrane Central Register ◽  
Valve Repair ◽  
Increased Risk ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Background: Mitral regurgitation (MR) is a rather common valvular heart disease. The purpose of this meta-analysis is to compare the outcomes, and complications of mitral valve replacement (MVR) with surgical mitral valve repair (MVr) of non-ischemic MR (NIMR).Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through Oct 2020. 4834 studies were reviewed, and only 20 studies enrolling a total of 21,898 patients with NIMR were included. Eligible studies were enrolling patients with MR and reporting early (30-day or in-hospital) or late all-cause mortality. For each study, data regarding all-cause mortality and incidence of reoperation and operative complications in both groups were used to generate odds ratios (ORs) or hazard ratios (HRs). Results: The pooled analysis showed that lower age, rate of women and incident of hypertension, significantly rates of diabetes and atrial fibrillation in MVR group than MVr group, no significant difference in rates of pre-operative left ventricle ejection fraction (LVEF) and heart failure. Subjects in MVr group is slightly less than MVR group. Replacement of MR has significantly increased risk of early and late mortality. Moreover, the rate of re-operation and post-operative MR in MVr group is lower than MVR group.Conclusions: In patients with NIMR, MVr procedure achieves higher survival and fewer complications than surgical MVR. Given these results, MVr surgery should be a priority for NIMR patients.

scholarly journals Outcome of mitral valve repair or replacement for non-ischemic mitral regurgitation: a systematic review and meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Qianqian Fan ◽  
Xiaoguang Li ◽  
Guilan Cao ◽  
Puliang Yu ◽  
Fengxiao Zhang
Keyword(s):  
Systematic Review ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Study Data ◽  
Cochrane Central Register ◽  
Number Of Patients ◽  
All Cause Mortality ◽  
Repair Group

Abstract Background Mitral regurgitation (MR) is a rather common valvular heart disease. The aim of this systematic review and meta-analysis was to compare the outcomes, and complications of mitral valve (MV) replacement with surgical MV repair of non-ischemic MR (NIMR) Methods MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched until October, 2020. Studies were eligible for inclusion if they included patients with MR and reported early (30-day or in-hospital) or late all-cause mortality. For each study, data on all-cause mortality and incidence of reoperation and operative complications in both groups were used to generate odds ratios (ORs) or hazard ratios (HRs). This study is registered with PROSPERO, CRD42018089608. Results The literature search yielded 4834 studies, of which 20 studies, including a total of 21,898 patients with NIMR, were included. The pooled analysis showed that lower age, less female inclusion and incident of hypertension, significantly higher rates of diabetes and atrial fibrillation in the MV replacement group than MV repair group. No significant differences in the rates of pre-operative left ventricle ejection fraction (LVEF) and heart failure were observed between groups. The number of patients in the MV repair group was lower than in the MV replacement group. We found that there were significantly increased risks of mortality associated with replacement of MR. Moreover, the rate of re-operation and post-operative MR in the MV repair group was lower than in the MV replacement group. Conclusions In patients with NIMR, MV repair achieves higher survival and leads to fewer complications than surgical MV replacement. In light of these results, we suggest that MV repair surgery should be a priority for NIMR patients.

Meta-analysis confirms improvement of hospitalizations and all-cause mortality of transcatheter mitral valve repair in functional mitral regurgitation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Noutsias ◽  
M Matiakis ◽  
B Bigalke ◽  
D Sedding ◽  
A Rigopoulos
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Meta Analysis ◽  
Functional Mitral Regurgitation ◽  
Clinical Effects ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
All Cause Mortality

Abstract Background Moderate-to-severe or severe functional mitral regurgitation (FMR) is associated with higher rates of hospitalizations and with increased mortality in heart failure (HF). Transcatheter mitral valve repair by MitraClip® implantation (TMVrMC) may effectively reduce severe MR, and is associated with symptomatic improvement. However, the long-term clinical effects of this procedure are not well defined. Aims We analyzed outcomes for rehospitalization and survival in HF patients with moderate-to-severe or severe FMR treated by either medical treatment (MT) only versus TMVrMC+MT by meta-analysis. Methods and results By systematic search of bibliographic databases, we evaluated publications comparing HF patients with FMR treated by MT only versus treatment by MT combined with TMVrMC. Studies with a minimum of 25 enrolled patients and a follow/up period of at least 12 months were deemed eligible for this meta-analysis. We identified n=7 studies enrolling 2,884 HFrEF patients, divided into two study arms: TMVrMC+MT (n=1,618), versus FMR patients receiving MT only (n=1,266). At 12 months, there was a significant reduction in all-cause mortality favoring TMVrMC+MT (OR: 0.65; CI 95% 0.53–0.79), compared with the MT only patients. At 24 months, a significant reduction of all-cause mortality in the TMVrMC+MT patient group (OR: 0.54; CI: 95%: 0.43–0.67; p<0.001) was calculated. TMVrMC+MT was associated with significantly lower rates of unplanned re-admissions for heart failure compared with MT only at 12 months (OR: 0.69; 95%; CI 0.53–0.89; p<0.001) and at 24 months (OR: 0.53; 95% CI: 0.39–0.71; p<0.001). In one publication, a survival benefit of TMVrMC+MT over MT alone was shown at 5 years post intervention (HR: 0.75; 95% CI: 0.69–0.94; p=0.012) after weighting for propensity score and controlling for age. Conclusions This meta-analysis on n=2,884 patients with moderate-to-severe or severe FMR reveals that TMVrMC+MT, as compared with MT alone, is associated with a significant reduction of rehospitalizations and improvement of survival up to 24 months after MitraClip implantation. However, the discordant results of 2 randomized controlled trials (MITRA-FR and COAPT) warrant further clarification, i.e. of the eligible FMR patient profiles who might benefit from TMVrMC+MT in terms of improvement of prognosis. These data imply additional evidence for TMVrMC in eligible HF patients with relevant FMR, which might be important for an update of the corresponding guidelines. Funding Acknowledgement Type of funding source: None

Comparison of Outcomes following Mitral Valve Repair versus Replacement for Chronic Ischemic Mitral Regurgitation: A Meta-Analysis

2016 ◽  
Vol 65 (06) ◽  
pp. 432-441 ◽  
Author(s):  
Deng Yun-dan ◽  
Du Wen-jing ◽  
Xiao Xi-jun
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Valve Replacement ◽  
Mitral Valve Repair ◽  
Operative Mortality ◽  
Meta Analysis ◽  
Ischemic Mitral Regurgitation ◽  
Valve Repair ◽  
High Quality ◽  
Chronic Ischemic Mitral Regurgitation

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.

scholarly journals Transcatheter Mitral Edge-to-Edge Repair in Patients with Primary or Secondary Mitral Regurgitation

2021 ◽  
Vol 1 (10) ◽  
Author(s):  
Kwakye Peprah ◽  
Holly Gunn ◽  
Melissa Walter
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Pacemaker Implantation ◽  
Vascular Complications ◽  
Kidney Injury ◽  
Clinical Effectiveness ◽  
Valve Repair ◽  
Significant Difference ◽  
Secondary Mitral Regurgitation

Four systematic reviews (SRs) and 6 retrospective cohort studies provided evidence for the clinical effectiveness of transcatheter mitral valve repair (TMVR) versus open heart conventional surgical mitral valve repair or replacement (SMVR) in patients with primary or secondary mitral regurgitation (MR). No relevant evidence regarding the cost-effectiveness of TMVR versus SMVR in patients with primary or secondary MR was identified; therefore, no summary can be provided. There was evidence indicating a statistically significant difference in favour of TMVR over SMVR regarding the odds of post-procedure bleeding, need for permanent pacemaker implantation, 30-day readmission, and a shorter duration of hospitalization. There was evidence suggesting a statistically significant difference in favour of SMVR over TMVR regarding the odds of recurrent MR, the need for reoperation, and mortality rate (i.e., during hospitalization, at 1 year, and > 3 years). Also, compared with TMVR, the likelihood of residual MR grade > 2 or freedom from MR grade ≥ 2 or ≥ 3 at 4 years was statistically significantly lower or higher, respectively, with SMVR. Evidence regarding the comparative clinical effectiveness of TMVR versus SMVR concerning stroke, acute kidney injury (AKI), cardiogenic shock, and death during hospitalization was conflicting and inconclusive. There was no evidence of a significant difference between the 2 interventions regarding overall mortality or mortality at 5 years, overall survival, freedom from cardiac death at 4 years, cardiac arrest, acute myocardial infarction (MI), and respiratory or vascular complications. A major limitation of the evidence was that it derives from studies of low or unknown quality and risk of bias, Furthermore, all the findings are confounded by differences in patient selection, which reflect the approved indications for the interventions but prevent a direct comparison between the TMVR and SMVR groups.

scholarly journals A Meta-Analysis of Mitral Valve Repair Versus Replacement for Ischaemic Mitral Regurgitation

2017 ◽  
Vol 26 ◽  
pp. S359-S360
Author(s):  
Christopher Cao ◽  
Sohaib Virk ◽  
Arunan Sriravindrarajah ◽  
Douglass Dunn ◽  
Kevin Liou ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Meta Analysis ◽  
Valve Repair

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

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
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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