Etiology-Specific Survival and Reoperation Trends Following Surgical Mitral Valve Repair and Replacement: A Meta-Analysis of Reconstructed Time-to-Event Data

Area of Science:

• Cardiology
• Cardiac Surgery
• Clinical Research

Background:

• Current guidelines favor mitral valve repair (MVr) over replacement (MVR) for mitral regurgitation.
• Evidence for MVr benefits is strong in degenerative mitral regurgitation (DMR) but less conclusive in other etiologies like infective endocarditis (IE), ischemic mitral regurgitation (IMR), and rheumatic heart disease (RHD).

Purpose of the Study:

• To compare the long-term outcomes of MVr versus MVR across different etiologies of mitral regurgitation.
• To evaluate survival rates and reoperation risks associated with MVr and MVR based on disease cause.

Main Methods:

• Systematic literature search for studies published after 2000 comparing MVr and MVR.
• Inclusion of studies on DMR, IE, IMR, and RHD, with analysis of 61 records from 59 studies (2005-2024).
• Utilized parametric time-varying hazard ratios, landmark analyses, and propensity-matched subgroup analyses.

Main Results:

• MVr demonstrated superior and sustained survival benefits over MVR in DMR and IE.
• In IMR and RHD, MVr's survival advantage was transient, with comparable hazards to MVR after six months and 2.7 years, respectively.
• MVr was associated with lower reoperation rates in DMR but higher rates in IE, IMR, and RHD compared to MVR.

Conclusions:

• Supports MVr over MVR for DMR due to sustained survival benefits.
• MVr is also beneficial for IE, supporting its prioritization when feasible.
• For IMR and RHD, the survival advantage of MVr is not sustained, and higher reoperation rates necessitate etiology-specific surgical planning.