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J Thorac Dis. 2017 Sep;9(9):3045-3051. doi: 10.21037/jtd.2017.08.43.

Mitral valve repair versus replacement in elderly patients: a systematic review and meta-analysis.

Author information

1
Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
2
Department of Intensive Care Unit, Wuhan No. 1 Hospital, Wuhan 430022, China.
3
Pediatric Intensive Care Unit, Hubei Maternal and Child Health Hospital, Wuhan 430022, China.

Abstract

Background:

Although mitral valve repair (MVP) is generally accepted as the standard treatment for mitral valve disease, in older patients, there is increasing debate about whether MVP is superior to mitral valve replacement (MVR). We, therefore, performed a meta-analysis to compare MVP vs. MVR in the elderly population.

Methods:

We systematically searched PubMed, the Cochrane Library, and Scopus up to February 2017 and scrutinized the references of relevant literatures. Only studies of MVP vs. MVR in the elderly patients (aged 70 years or older) that were published after 2000 were included.

Results:

The retrieval process yielded seven observational clinical studies with 1,809 patients. Compared with MVR, MVP was associated with a significantly reduced 30-day mortality [risk ratio (RR): 0.40, 95% confidence interval (CI): 0.25-0.64], with shorter duration of postoperative hospital stay (days) (weighted mean difference: -1.47, 95% CI: -2.47--0.48) and less postoperative complications (RR: 0.69, 95% CI: 0.56-0.86). In addition, our study also demonstrated improved 1-year (RR: 1.16, 95% CI: 1.08-1.24) and 5-year (RR: 1.26, 95% CI: 1.13-1.41) survival rates following MVP. There was no difference in reoperations between these two surgery approaches.

Conclusions:

The present meta-analysis indicates that elderly patients who receive MVP have better early and late outcomes than those undergoing MVR. MVP may be the preferred strategy for mitral valve surgery in the elderly population.

KEYWORDS:

Mitral valve repair (MVP); elderly; meta-analysis; mitral valve replacement (MVR)

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

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