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Title: Meta-analysis of two different surgical treatments of ischaemic mitral regurgitation with the same outcome: mitral valve repair vs mitral valve replacement
Author(s): H. Zhang , Y. Liu , J. Bin , S. Qiu , F. Chen
Journal: Acta Cardiologica
Volume: 71    Issue: 5   Date: 2016   
Pages: 573-580
DOI: 10.2143/AC.71.5.3167501

Abstract :
Background: Mitral valve replacement (MVR) and mitral valve repair (MVP) are the most common clinical treatment for ischaemic mitral insufficiency (IMR). But controversy exists on the optimal surgical strategy for IMR.
Methods: A literature search was performed in OvidSP, PubMed and Cochrane Library to find articles comparing MVP versus MVR for the treatment of IMR. A meta-analysis was performed for the differences in short- and long-term survival. Secondary outcomes analysed the postoperative left ventricular diastolic diameter (LVDD), left ventricular ejection fraction (LVEF) and the New York Heart Association (NYHA) class.
Results: Out of the 584 studies, we only included 12 articles. A total of 2953 patients were enrolled, including 1731 patients in the MVP group and 1222 patients in the MVR group. The total number of bioprosthesis valves was 1.2 times (631/535) the number of mechanical valves. After surgery, LVDD and LVEF had improved and the proportion of NYHA III-IV class declined, but the differences between the two groups were not significant (P > 0.05). Short-term survival in the MVP group was higher than that in the MVR group (odds ratio [OR], 0.44; 95% confidence interval [CI] 0.32-0.60; P < 0.00001). Long-term survival was similar in both two groups (hazard ratio [HR], 0.86; 95% CI 0.68-1.10, P = 0.24).
Conclusion: Both MVP and MVR can play a role in reducing IMR and improving left ventricular function. The short-term survival of MVP is better than MVR but long-term survival is similar. Further exploration is needed to install optimal treatment of IMR and individualized therapy.

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