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Eur J Cardiothorac Surg 2007;31:267-275. doi:10.1016/j.ejcts.2006.11.014
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Review

Meta-analysis of clinical outcomes following surgical mitral valve repair or replacement

^a Loyola University Stritch School of Medicine, Department of Thoracic and Cardiovascular Surgery, Maywood, IL 60153, United States
^b Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL 60612, United States

Received 13 March 2006; received in revised form 31 October 2006; accepted 14 November 2006.

^_* Corresponding author. Address: 42 Hamdenway Papworth Everard, Cambridge CB3 8UG, United Kingdom. Tel.: +1 312 404 8710; fax: +1 708 327 2503. (Email: jeffrey01{at}mac.com).

Although the use of mitral valve surgery has been successful at alleviating mitral valve disease, published studies on either replacement or repair have yielded mixed clinical outcomes regarding differences between repair and replacement. Meta-analysis of various outcomes from 29 published studies was conducted. Studies were separated into four groups by etiology of disease: ischemic; degenerative/myxomatous; rheumatic and mixed. The summary odds ratio for early mortality, comparing replacement to repair, was 2.24 (1.78–2.80), while the summary total survival hazard ratio was 1.58 (1.41–1.78), replacement compared to repair, indicating worse outcomes among those undergoing mitral valve replacement. The risk of thromboembolism was lower in the repair group (summary hazard ratio = 1.86, replacement vs. repair), while there was no statistical difference in time to re-operation between the two treatment groups (hazard ratio = 0.88 [95% confidence interval: 0.48, 1.62]). Analysis stratified by etiologic classification was able to detect strong evidence of differences in 30-day and total survival outcomes favoring repair for three disease groups (rheumatic, mixed and degenerative). Surgery for ischemic mitral valve had lower 30-day mortality for repair than replacement, but no statistically significant difference in the overall survival was detected. The reported information in the published studies used in the current work lacks sufficient detail to allow summary determination of outcomes by mitral valve repair techniques and by type of mitral valve replacement.

Key Words: Mitral valve repair • Mitral valve replacement • Meta-analysis

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