European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Sep 2015
Review Meta Analysis Comparative StudyOutcomes of mitral valve repair compared with replacement in patients undergoing concomitant aortic valve surgery: a meta-analysis of observational studies.
Long-term superiority of mitral valve (MV) repair compared with replacement is well established in degenerative MV disease. In rheumatic heart disease, its advantages are unclear and it is often performed in conjunction with aortic valve (AV) replacement. Herein, we performed a systematic review and meta-analysis comparing outcomes of MV repair vs replacement in patients undergoing concomitant AV replacement. ⋯ In a separate analysis of studies with exclusively rheumatic patients (n = 1106), the early as well as late mortality benefit of MV repair was lost (RR: 0.92, 95% CI: 0.44-1.90, P = 0.81 and RR: 0.69, 95% CI: 0.39-1.22, P = 0.199, respectively), whereas the MV reoperation rate became significantly higher (RR: 5.10, 95% CI: 1.62-16.05, P = 0.005) with MV repair. In patients undergoing concomitant mitral and AV surgery, MV repair is associated with improved early and late survival without any increased risk for mitral valve reoperation. However, in patients with rheumatic heart disease MV repair does not impart any survival advantage while the risk for MV reoperation remains significantly higher.