BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate the available literature comparing mitral valve repair (MVRep) versus mitral valve replacement (MVR) in the elderly population, and to provide a pooled analysis regarding this issue. METHODS: Medline, Embase, Cochrane, trial registries, conference proceedings and reference lists were searched for trials of MVRep versus MVR surgery in the elderly population. The primary outcome was 30-day mortality, while secondary outcomes were postoperative complications and length of hospital stay. Pooled odds ratios were calculated for categorical outcomes and weighted mean differences for continuous outcomes. RESULTS: Four studies retrieved were deemed appropriate for inclusion. The outcome measures used for the analysis clearly showed a benefit of MVRep in the elderly population with reduced mortality (pooled Odds Ratio (OR) = 3.97; p = 0.003) and reduced postoperative complications (pooled OR = 2.35; p = 0.003). There was no significant difference between the two groups with regards to duration of hospital stay (weighted mean difference = 0.22; p = 0.18). CONCLUSION: With the demonstration of clear advantages of MVRep over MVR in the elderly population, a randomized trial between the two techniques is not ethically justifiable. As there are clear advantages to MVRep, it is recommended that this should be the primary treatment offered in mitral valve pathology, irrespective of the patient's age.
BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate the available literature comparing mitral valve repair (MVRep) versus mitral valve replacement (MVR) in the elderly population, and to provide a pooled analysis regarding this issue. METHODS: Medline, Embase, Cochrane, trial registries, conference proceedings and reference lists were searched for trials of MVRep versus MVR surgery in the elderly population. The primary outcome was 30-day mortality, while secondary outcomes were postoperative complications and length of hospital stay. Pooled odds ratios were calculated for categorical outcomes and weighted mean differences for continuous outcomes. RESULTS: Four studies retrieved were deemed appropriate for inclusion. The outcome measures used for the analysis clearly showed a benefit of MVRep in the elderly population with reduced mortality (pooled Odds Ratio (OR) = 3.97; p = 0.003) and reduced postoperative complications (pooled OR = 2.35; p = 0.003). There was no significant difference between the two groups with regards to duration of hospital stay (weighted mean difference = 0.22; p = 0.18). CONCLUSION: With the demonstration of clear advantages of MVRep over MVR in the elderly population, a randomized trial between the two techniques is not ethically justifiable. As there are clear advantages to MVRep, it is recommended that this should be the primary treatment offered in mitral valve pathology, irrespective of the patient's age.
Authors: Simon H Sündermann; Michael Gessat; Nikola Cesarovic; Thomas Frauenfelder; Patric Biaggi; Dominique Bettex; Volkmar Falk; Stephan Jacobs Journal: Interact Cardiovasc Thorac Surg Date: 2013-01-03
Authors: Rebecca H Maier; Adetayo S Kasim; Joseph Zacharias; Luke Vale; Richard Graham; Antony Walker; Grzegorz Laskawski; Ranjit Deshpande; Andrew Goodwin; Simon Kendall; Gavin J Murphy; Vipin Zamvar; Renzo Pessotto; Clinton Lloyd; Malcolm Dalrymple-Hay; Roberto Casula; Hunaid A Vohra; Franco Ciulli; Massimo Caputo; Serban Stoica; Max Baghai; Gunaratnam Niranjan; Prakash P Punjabi; Olaf Wendler; Leanne Marsay; Cristina Fernandez-Garcia; Paul Modi; Bilal H Kirmani; Mark D Pullan; Andrew D Muir; Dimitrios Pousios; Helen C Hancock; Enoch Akowuah Journal: BMJ Open Date: 2021-04-14 Impact factor: 2.692