Mitral valve re-repair vs replacement following failed initial repair: a systematic review and meta-analysis

ABSTRACT NUMBER: NESTAC MEDAL FOR MEDICAL STUDENTS_2

 

AUTHOR
Prash Cheekoty

MAIN ABSTRACT TEXT

Introduction
Although the incidence and causes of mitral valve repair failure is well documented, the optimal treatment strategy following a failed mitral valve repair remains unclear. This study aims to compare and analyse all available studies which report the clinical outcomes post mitral valve re-repair versus replacement after a prior mitral valve repair. This is extremely signi cant as it would provide more clarity to cardiac surgeons, possibly in uencing their operative method, as well as potentially improve patient outcomes.

Methods
Based on PRISMA guidelines, a literature search was performed utilising PubMed, Cochrane and Scopus databases to identify retrospective cohort studies that reported outcomes of valve re-repair and valve replacement after a prior mitral valve repair. Data regarding operative mortality, clinical outcomes and complications were extracted, synthesised and meta-analysed where appropriate.

Results
Eight studies with a total cohort of 1632 patients were used. After analysis, no signi cant di erences in the short term and long-term operative mortality, incidence of stroke, congestive heart failure, Grade 1 and Grade 2 mitral regurgitation, requirement of 3rd mitral valve operation and reoperation due bleeding were found between the two groups. However, a slightly higher incidence of postoperative atrial  brillation (OR: 0.11, CI: 0.02 to 0.17, I2 = 0%, p = 0.02) was observed in the replacement group, as compared to the re-repair group.

Conclusion
Mitral valve re-repair appears to be a viable alternative to mitral valve replacement for mitral valve reoperation, given that it is associated with similar post-operative outcomes.