Meta-analysis Of The Efficacy And Safety Of Mitral Valve Repair Versus Replacement For Rheumatic Mitral Valve Disease

Objective: Currently,valve repair or replacement is performed for rheumatic mitral valve disease.The study aim is to evaluate the clinical efficacy and safety of two surgical methods(valve repair or replacement)for rheumatic mitral heart disease by Meta analysis,and to provide evidence-based reference for clinical treatment.Methods: A computer system is used to search Chinese and foreign literature(CNKI,Wanfang datebases,Web of Science,Google Scholar,VIP,CBM,Pubmed,Embase,The Cochran Library etc),with manual searching.Through a comprehensive search for cohort study of mitral valve repair and replacement for rheumatic mitral valve patients.After filtrating the literature according to the inclusion and exclusion criteria of the literature,two researchers reviewed the literature: quality assessment,data extraction and tabulation.Finally the author used Meta analysis of the date gathering from the studies by software of RevMan5.3 and STATA14.0.Results: Finally 8 retrospective cohort studies were included from January 1,2000 to January 31,2019 comparing MVP and MVR.The total number of cases is 3702,of which 1091 cases of the mitral valverepair group and 2011 cases of the mitral valve replacement group.The results of Meta analysis shows that there was a significant difference in the all-cause mortality at 30 days(OR=0.41,95%CI [0.24,0.70],P=0.001),long-term follow-up survival(HR=0.63,95%CI [0.47,0.83],P=0.001),and the incidence of major adverse events(HR=0.66,95%CI[0.52,0.83],P=0.0005),that is,the mitral valve repair groups was superior to the replacement groups.However,the mitral repair groups had a significantly higher rate of reoperation than the valve repair groups(HR= 2.16,95% CI)[1.80,2.59],P<0.00001).Conclusions: MVP is superior to MVR for the 30 days mortality,long-term follow-up survival and postoperative adverse events(mainly anticoagulation-related bleeding and thrombosis).MVR is superior to MVP for avoiding reoperation.But,the author believes that mitral valve repair can avoid troublesome lifelong anticoagulant therapy and related complications.Through the correct understanding of the treatment of mitral valve repair,combined with the specific circumstances of the patient,valve repair should be tried when Technology is feasible.