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Benefits of mitral valve repair over replacement in the elderly: a systematic review and meta‐analysis
Author(s) -
Di Tommaso Ettorino,
Rapetto Filippo,
Guida Gustavo A.,
Zakkar Mustafa,
Bruno Vito D.
Publication year - 2021
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15506
Subject(s) - medicine , meta analysis , relative risk , surgery , cardiopulmonary bypass , observational study , mitral valve repair , population , mitral valve , cardiology , confidence interval , environmental health
Objectives Mitral valve (MV) repair has demonstrated excellent short‐ and long‐term outcomes, however, its merit in the elderly population is still debated. We conducted a meta‐analysis of studies that have compared the MV repair to replacement in the elderly population. Methods A systematic literature search was conducted for any study published on MV surgery on elderly patients (≥75 years old). A pooled risk‐ratio meta‐analysis was done to evaluate short‐term mortality, postoperative complications, surgical timings, and long‐term survival rates. Results A total of nine retrospective observational studies were included in the quantitative meta‐analysis. Pooled meta‐analysis showed a reduced risk of short‐term mortality for the MV repair group (risk ratio [RR] = 0.41 [0.24–0.71], p ‐value = .005). Postoperative neurological complications were in favor of repair, although not significantly (RR = 0.49 [0.21–1.11], p ‐value = .07). Operative timings (cardiopulmonary bypass and crossclamp time) were not different between the groups although no data were available on the complexity of the repairs. Long‐term survival rates were in favor of the repairs (pooled treatment effect of −0.47 [−0.64; −0.29], p = .005). Conclusions MV surgery is a safe and effective procedure for the elderly. MV repair demonstrated better short‐term outcomes compared to replacement. Long‐term survival rates are significantly better after repair.