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PubMed · 9593545

New developments in mitral valve repair.

R Espada·S Westaby
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Abstract

The etiology of mitral valve disease is changing. The predominance of rheumatic pathology has given way to degenerative pathology in an increasingly elderly population. Mitral valve conservation by repair rather than replacement has several advantages. Repair is associated with a lower incidence of thromboembolism, hemolysis, and infectious endocarditis. For patients in sinus rhythm, thromboembolism is rare and anticoagulation can be discontinued. Repair also is associated with improved long-term survival. This article reviews the current literature on different types of surgical techniques for repair of the mitral valve and discusses future trends.

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Heart Valve DiseasesHumansMitral ValveMitral Valve InsufficiencyMitral Valve ProlapsePostoperative ComplicationsRheumatic Heart DiseaseSuture TechniquesVentricular Outflow ObstructionJournal ArticleReview

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R Espada, S Westaby. 1998. New developments in mitral valve repair.. https://doi.org/10.1097/00001573-199803000-00002

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

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.

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