Amer Harky1,2, Alexander Hof3, Megan Garner1, Saied Froghi4, Mohamad Bashir1. 1. Department of Cardiac Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, UK. 2. Department of Vascular Surgery, Countess of Chester Hospital, Chester, UK. 3. Department of Cardiovascular Surgery, Heinrich-Heine-University, Medical Faculty, Dusseldrof, Germany. 4. Department of Surgery, Imperial College NHS Trust, Hammersmith Hospital, London, UK.
Abstract
OBJECTIVE: The objective of this study is to review the morbidity and mortality associated with mitral valve repair versus replacement in infective endocarditis patients. METHODS: A comprehensive search was undertaken among the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all available data comparing mitral valve repair or replacement in infective endocarditis. Databases were evaluated and assessed to March 2017. Data were analyzed using meta-analytical techniques including odds ratio and mean weighted difference. RESULTS: A total of 8978 patients were analyzed in a total of 14 articles. The average age of the cohort was 53 years. Results revealed a shorter CPB time in the mitral valve (MV) repair compared to replacement group (P = 0.05). Postoperative outcomes (30 days/in hospital events) such as bleeding (P = 0.0047) and recurrence of infective endocarditis (IE) (P = 0.004) were significantly lower in the MV repair group. Beyond 30 days, recurrence of IE was higher in the MV replacement than the repair group (P < 0.0001). Additionally, there were significantly less reoperations in the repair group (P = 0.0021). The MV repair group had significantly better survival at 1 and 5 years postop (P < 0.0001, P < 0.0001). CONCLUSION: This meta-analysis shows that mitral valve repair has good clinical outcomes both in-hospital and at 1 and 5 years of follow-up. Mitral valve repair should be attempted in those patients in whom sufficient valve tissue is present for reconstruction after all infectious tissue has been resected.
OBJECTIVE: The objective of this study is to review the morbidity and mortality associated with mitral valve repair versus replacement in infective endocarditispatients. METHODS: A comprehensive search was undertaken among the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all available data comparing mitral valve repair or replacement in infective endocarditis. Databases were evaluated and assessed to March 2017. Data were analyzed using meta-analytical techniques including odds ratio and mean weighted difference. RESULTS: A total of 8978 patients were analyzed in a total of 14 articles. The average age of the cohort was 53 years. Results revealed a shorter CPB time in the mitral valve (MV) repair compared to replacement group (P = 0.05). Postoperative outcomes (30 days/in hospital events) such as bleeding (P = 0.0047) and recurrence of infective endocarditis (IE) (P = 0.004) were significantly lower in the MV repair group. Beyond 30 days, recurrence of IE was higher in the MV replacement than the repair group (P < 0.0001). Additionally, there were significantly less reoperations in the repair group (P = 0.0021). The MV repair group had significantly better survival at 1 and 5 years postop (P < 0.0001, P < 0.0001). CONCLUSION: This meta-analysis shows that mitral valve repair has good clinical outcomes both in-hospital and at 1 and 5 years of follow-up. Mitral valve repair should be attempted in those patients in whom sufficient valve tissue is present for reconstruction after all infectious tissue has been resected.