Repair or replacement for severe ischemic mitral regurgitation: A meta-analysis

BACKGROUND: The best surgical option for severe ischemic mitral regurgitation (IMR) is still controversial. The aim of this study was to perform a meta-analysis to compare the clinical outcomes of mitral valve repair (MVP) with replacement (MVR). METHODS: A literature search was conducted in PubMed, Embase, and Medline using the terms “ischemic mitral regurgitation” and “repair or annuloplasty or reconstruction” and “replacement” in the title/abstract field. The primary outcomes of interest were perioperative mortality and long-term survival. Secondary outcomes were mitral regurgitation (MR) recurrence and reoperation. RESULTS: Of 276 studies, 13 studies met the inclusion and exclusion criteria. A total of 1993 patients were included in these studies, consisting of 1259 (63%) repair cases, and 734 (37%) replacement cases. Perioperative mortality was lower with MVP compared with MVR [OR 0.61; (95% CI, 0.43–0.87; P < .05)]. There was no difference with respect to long-term survival [HR 0.75; (95% CI, 0.52–1.09; P = .14)] and reoperation [OR 0.77; (95% CI, 0.38–1.57; P = .47)]. MVP is associated with a higher recurrence of MR [OR = 4.09; (95% CI, 1.82–9.19; P < .001)]. CONCLUSION: MVP is associated with a lower perioperative mortality but a higher recurrence of MR compared with MVR for severe IMR. No differences were found with respect to long-term survival and reoperation.