Mitral valve re-repair vs replacement following failed initial repair: a systematic review and meta-analysis
- PDF / 1,308,675 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 5 Downloads / 212 Views
(2020) 15:304
REVIEW
Open Access
Mitral valve re-repair vs replacement following failed initial repair: a systematic review and meta-analysis Muthu Veerappan1,2 , Prashasth Cheekoty1,3 , Faizus Sazzad1,4,5
and Theo Kofidis1,4,5*
Abstract Background: The optimal treatment strategy following a failed mitral valve repair remains unclear. This study aims to compare and analyse available studies which report the clinical outcomes post mitral valve re-repair (MVr) or replacement (MVR) after a prior mitral valve repair. Methods: Based on PRISMA guidelines, a literature search was performed utilising PubMed, Cochrane and Scopus databases to identify retrospective cohort studies that reported outcomes of MVr and MVR after a prior mitral valve repair. Data regarding operative mortality, clinical outcomes and complications were extracted, synthesized and meta-analysed where appropriate. Results: Eight studies with a total cohort of 1632 patients were used. After analysis, no significant differences in the short term and long-term operative mortality, incidence of stroke, congestive heart failure, Grade 1 and Grade 2 mitral regurgitation, requirement of 3rd mitral valve operation and reoperation due bleeding were found between the two groups. However, a slightly higher incidence of postoperative atrial fibrillation (OR: 0.11, CI: 0.02 to 0.17, I2 = 0%, p = 0.02) was observed in the MVR group, as compared to the MVr group. Conclusion: MVr appears to be a viable alternative to MVR for mitral valve reoperation, given that they are associated with similar post-operative outcomes. Keywords: Meta-analysis, Mitral valve, Re-repair, Replacement
Introduction Mitral regurgitation is the second most frequent indication for valve surgery in industrialised countries, with an overall prevalence of 9.3% in the general population who are above 75 years old [1]. Traditionally, mitral valve replacement was the preferred option of treatment among surgeons as the valve repair was technically more demanding [2]. However, there has been a surge in * Correspondence: [email protected]; [email protected] 1 Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System-NUHS, 1E Kent Ridge Road, 9th Floor, Tower Block, Singapore 119228, Singapore 4 Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Full list of author information is available at the end of the article
development of repair techniques post introduction of Carpentier’s techniques [3]. Numerous qualified centres have reported excellent outcomes after mitral valve repair thanks to its reproducible clinical results [4–7]. Therefore, mitral valve repair has been identified as the optimal intervention strategy to correct significant mitral regurgitation [8]. However, the incidence of reoperation after initial mitral valve repair failure estimates at 4.5 to 8% at 10 years [7]. The causes of incomplete repair can be categorised into procedure related and valve related fac
Data Loading...
