Mitral valve repair vs. replacement: Surgeons track long-term outcomes in patients with infective endocarditis
Infective endocarditis (IE) of the mitral valve (MV) is often treated with one of two surgical procedures: MV repair or MV replacement. Seeking a clear consensus of the most effective strategy, researchers performed a new meta-analysis of 21 different studies comparing MV repair with MV replacement. The group shared its findings in The American Journal of Cardiology.[1]
The meta-analysis included a total of 4,607 patients While 36.3% of patients underwent MV repair, the remaining 63.7% underwent MV replacement. Patients were followed for up to 16 years.
Three different statistical tests—Logrank, Breslow and Tarone-Ware—all found that MV repair was associated with a significant improvement in long-term mortality compared to MV replacement. The authors also found that IE recurrence was significantly less likely after MV repair than it was after MV replacement. Freedom from reoperation, however, was comparable between the two techniques.
“Mitral valve IE still represents a challenging surgical condition with high morbidity and mortality,” wrote first author Giuseppe Comentale, MD, PhD, a cardiothoracic surgeon with the University of Naples Federico II in Naples, and colleagues. “MV repair for IE has proven to be a good and safe option, compared to replacement, both in the short and in the long term, but current trends favor replacement, especially in active endocarditis.”
Comentale et al. did note that patients who typically undergo MV repair are “very different from those treated with MV replacement,” making it more challenging to make conclusive comparisons between the two populations. Even with that limitation in mind, however, the group believes it has highlighted the benefits of MV repair over MV replacement when treating IE.
“MV repair appears to be clearly a good and safe option in case of MV IE both in terms of IE recurrence and long-term results,” the group wrote, emphasizing that there will still be many patients who are not good candidates for MV repair and will require MV replacement.
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.