Mitral Valve Repair for Anterior/Bi-leaflet Versus Posterior Leaflet Degenerative Mitral Valve Disease: A Systematic Review and Meta-analysis |
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| Affiliation: | 1. Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan;2. Department of Internal Medicine, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India;3. Department of General Surgery, Mayo Clinic, Rochester, MN;4. Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH;5. Section of Cardiovascular Research, Heart, Vascular and Thoracic Department, Cleveland Clinic Akron General, Akron, OH;6. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN;1. Department of Ophthalmology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio;2. Department of Cardiology, University of Kansas Medical Center, Kansas, Kansas;3. Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio;4. Department of Internal Medicine, Saint Peter''s University Hospital, New Brunswick, New Jersey;5. Department of Clinical Research, Icahn School of Medicine at Mount Sinai, New York, New York;6. Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana;1. Department of Medicine, Miami Valley Hospital, Columbus, OH;2. Department of Medicine, University of Connecticut, Farmington, CT;3. Department of Cardiology, New York Medical College at Westchester Medical Center, New York, NY;4. Department of Cardiology, University of Kansas, Kansas City, KS;5. Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY;6. Department of Cardiology, Lehigh Valley Health Network, Allentown, PA;7. Department of Cardiology, Baylor College of Medicine, TX;1. Cardiorespiratory Emergencies, Hospital General de México “Dr Eduardo Liceaga”, 06720, Mexico City, Mexico;2. Pulmonary Circulation Clinic, Hospital General de México “Dr. Eduardo Liceaga”, 06720, Mexico City, Mexico;3. Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico;4. Pulmonology Department, Hospital General de México “Dr. Eduardo Liceaga”, 06720, Mexico City, Mexico;5. Directorate of Research, Hospital General de Mexico “Dr. Eduardo Liceaga,” 06720, Mexico City, Mexico;6. I.M. Sechenov First Moscow State Medical University (Sechenov University), Department of Radiology, 119992, Moscow, Russia;7. Radiology Service, Hospital General de México “Dr Eduardo Liceaga”, 06720, Mexico City, Mexico;1. Department of Medicine, Duke University Medical Center, Durham, NC, USA;2. Duke Clinical Research Institute, Durham, NC, USA;3. Department of Medicine, Ziauddin Medical University, Karachi, Pakistan;4. Department of Medicine, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA;5. Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA;6. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA;7. Department of Medicine, St Boniface Hospital University of Manitoba, Winnipeg, MB, Canada;1. Section of Clinical Cardiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio;2. Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio;3. Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Aortic Valve Center, Sydell and Arnold Miller Family Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio;4. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio |
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| Abstract: | Mitral valve repair (MVr) secondary to degenerative anterior/bi-leaflet mitral valve disease is more challenging than posterior leaflet repair. However, conclusive evidence is needed to make decisions based on the outcomes rather than technical difficulties. This meta-analysis compares anterior/bi-leaflet MVr with isolated posterior leaflet repair in patients with mitral regurgitation (MR) due to degenerative mitral valve disease. The outcomes of interest were long-term (≥ 5 years) survival and freedom from re-operation and moderate-to-severe MR. Meta-analysis of 10 studies showed that there was no significant difference in long-term survival (risk ratio, RR: 1.00; 95% confidence interval, 95% CI 0.96-1.04), freedom from moderate-to-severe MR (RR: 0.95; 95% CI 0.87-1.03), and freedom from re-operation (RR: 0.96; 95% CI 0.90-1.02) between anterior/bi-leaflet MVr and posterior leaflet repair. As outcomes of anterior/bilateral repair were comparable with those of isolated posterior leaflet repair, our findings do not support the inclination towards replacement over repair for MR caused by anterior/bilateral degenerative mitral disease. |
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