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Mitral Valve Surgery in Patients With Rheumatic Heart Disease: Repair vs. Replacement
Background: High morbidity and mortality caused by rheumatic heart disease (RHD) are global burdens, especially in low-income and developing countries. Whether mitral valve repair (MVP) benefits RHD patients remains controversial. Thus, we performed a meta-analysis to compare the perioperative and l...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193043/ https://www.ncbi.nlm.nih.gov/pubmed/34124209 http://dx.doi.org/10.3389/fcvm.2021.685746 |
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author | Fu, Guangguo Zhou, Zhuoming Huang, Suiqing Chen, Guangxian Liang, Mengya Huang, Lin Wu, Zhongkai |
author_facet | Fu, Guangguo Zhou, Zhuoming Huang, Suiqing Chen, Guangxian Liang, Mengya Huang, Lin Wu, Zhongkai |
author_sort | Fu, Guangguo |
collection | PubMed |
description | Background: High morbidity and mortality caused by rheumatic heart disease (RHD) are global burdens, especially in low-income and developing countries. Whether mitral valve repair (MVP) benefits RHD patients remains controversial. Thus, we performed a meta-analysis to compare the perioperative and long-term outcomes of MVP and mitral valve replacement (MVR) in RHD patients. Methods and Results: A systematic literature search was conducted in major databases, including Embase, PubMed, and the Cochrane Library, until 17 December 2020. Studies comparing MVP and MVR in RHD patients were retained. Outcomes included early mortality, long-term survival, freedom from reoperation, postoperative infective endocarditis, thromboembolic events, hemorrhagic events, and freedom from valve-related adverse events. Eleven studies that met the inclusion criteria were included. Of a total of 5,654 patients, 1,951 underwent MVP, and 3,703 underwent MVR. Patients who undergo MVP can benefit from a higher long-term survival rate (HR 0.72; 95% CI, 0.55–0.95; P = 0.020; I(2) = 44%), a lower risk of early mortality (RR 0.62; 95% CI, 0.38–1.01; P = 0.060; I(2) = 42%), and the composite outcomes of valve-related adverse events (HR 0.60; 95% CI, 0.38–0.94; P = 0.030; I(2) = 25%). However, a higher risk of reoperation was observed in the MVP group (HR 2.60; 95% CI, 1.89–3.57; P<0.001; I(2) = 4%). Patients who underwent concomitant aortic valve replacement (AVR) in the two groups had comparable long-term survival rates, although the trend still favored MVP. Conclusions: For RHD patients, MVP can reduce early mortality, and improve long-term survival and freedom from valve-related adverse events. However, MVP was associated with a higher risk of reoperation. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=228307. |
format | Online Article Text |
id | pubmed-8193043 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-81930432021-06-12 Mitral Valve Surgery in Patients With Rheumatic Heart Disease: Repair vs. Replacement Fu, Guangguo Zhou, Zhuoming Huang, Suiqing Chen, Guangxian Liang, Mengya Huang, Lin Wu, Zhongkai Front Cardiovasc Med Cardiovascular Medicine Background: High morbidity and mortality caused by rheumatic heart disease (RHD) are global burdens, especially in low-income and developing countries. Whether mitral valve repair (MVP) benefits RHD patients remains controversial. Thus, we performed a meta-analysis to compare the perioperative and long-term outcomes of MVP and mitral valve replacement (MVR) in RHD patients. Methods and Results: A systematic literature search was conducted in major databases, including Embase, PubMed, and the Cochrane Library, until 17 December 2020. Studies comparing MVP and MVR in RHD patients were retained. Outcomes included early mortality, long-term survival, freedom from reoperation, postoperative infective endocarditis, thromboembolic events, hemorrhagic events, and freedom from valve-related adverse events. Eleven studies that met the inclusion criteria were included. Of a total of 5,654 patients, 1,951 underwent MVP, and 3,703 underwent MVR. Patients who undergo MVP can benefit from a higher long-term survival rate (HR 0.72; 95% CI, 0.55–0.95; P = 0.020; I(2) = 44%), a lower risk of early mortality (RR 0.62; 95% CI, 0.38–1.01; P = 0.060; I(2) = 42%), and the composite outcomes of valve-related adverse events (HR 0.60; 95% CI, 0.38–0.94; P = 0.030; I(2) = 25%). However, a higher risk of reoperation was observed in the MVP group (HR 2.60; 95% CI, 1.89–3.57; P<0.001; I(2) = 4%). Patients who underwent concomitant aortic valve replacement (AVR) in the two groups had comparable long-term survival rates, although the trend still favored MVP. Conclusions: For RHD patients, MVP can reduce early mortality, and improve long-term survival and freedom from valve-related adverse events. However, MVP was associated with a higher risk of reoperation. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=228307. Frontiers Media S.A. 2021-05-28 /pmc/articles/PMC8193043/ /pubmed/34124209 http://dx.doi.org/10.3389/fcvm.2021.685746 Text en Copyright © 2021 Fu, Zhou, Huang, Chen, Liang, Huang and Wu. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Fu, Guangguo Zhou, Zhuoming Huang, Suiqing Chen, Guangxian Liang, Mengya Huang, Lin Wu, Zhongkai Mitral Valve Surgery in Patients With Rheumatic Heart Disease: Repair vs. Replacement |
title | Mitral Valve Surgery in Patients With Rheumatic Heart Disease: Repair vs. Replacement |
title_full | Mitral Valve Surgery in Patients With Rheumatic Heart Disease: Repair vs. Replacement |
title_fullStr | Mitral Valve Surgery in Patients With Rheumatic Heart Disease: Repair vs. Replacement |
title_full_unstemmed | Mitral Valve Surgery in Patients With Rheumatic Heart Disease: Repair vs. Replacement |
title_short | Mitral Valve Surgery in Patients With Rheumatic Heart Disease: Repair vs. Replacement |
title_sort | mitral valve surgery in patients with rheumatic heart disease: repair vs. replacement |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193043/ https://www.ncbi.nlm.nih.gov/pubmed/34124209 http://dx.doi.org/10.3389/fcvm.2021.685746 |
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