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Meta-Analysis
. 2024 Apr 18;19(1):247.
doi: 10.1186/s13019-024-02767-y.

To repair or to replace in mitral valve infective endocarditis? an updated meta-analysis

Ahmed K Awad  1   2 , Karim Wilson  3 , Mahmoud A Elnagar  1 , Merihan A Elbadawy  1 , Mohamed H Fathy  1
Affiliations
Meta-Analysis

To repair or to replace in mitral valve infective endocarditis? an updated meta-analysis

Ahmed K Awad et al. J Cardiothorac Surg. .

Abstract

Background: Valve infective endocarditis (IE) is a potentially life-threatening condition that affects patients' livelihoods. Current surgical options in mitral valve IE include mitral valve repair (MVr) or replacement (MVR). While each procedure boasts its merits, doubt remains as to which type of surgery is superior.

Methods: We searched PubMed, Scopus, Web of Science, and Cochrane literature databases for studies comparing MVR and MVr in mitral valve IE. Any randomized controlled trial (RCT) or observational studies that compare MVR vs. MVr in mitral valve IE were eligible. Our dichotomous outcomes were extracted in the form of event and total, and risk and hazard ratio (RR)(HR) with 95% confidence interval (CI) and were pooled and calculated using RevMan 5.0.

Results: Our study included 23 studies with a total population of 11,802 patients. Compared to MVR, MVr had statistically significant lower risks of both early mortality with RR [0.44; 95% CI, 0.38-0.51; p < 0.001] and long-term follow-up mortality with HR [0.70; 95% CI, 0.58-0.85; p = 0.0004]. Moreover, MVr was associated with a statistically significant lower risk of IE recurrence with RR [0.43; 95% CI, 0.32-0.58; p < 0.001]; however, no statistically significant differences between both groups in terms of re-operations with RR [0.83; 95% CI, 0.41-1.67; p = 0.60].

Conclusion: Our results suggest that MVr was superior in terms of in-hospital mortality, long-term survival, and risk of recurrence without significance in valve reoperation. Therefore, MVr is appropriate as a primary treatment choice and should be considered whenever possible in most IE patients.

Keywords: Endocarditis; Infective endocarditis; Mitral replacement; Mitral valve repair.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Forrest plot analysis of early mortality
Fig. 2
Fig. 2
Forrest plot analysis of late mortality
Fig. 3
Fig. 3
Forrest plot analysis of infective endocarditis recurrence
Fig. 4
Fig. 4
Forrest plot analysis of reoperation
See this image and copyright information in PMC

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