Jiang Yefan, Wang Chen, Li Geng, Chen Si
Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Ann Transl Med. 2021 Feb;9(3):204. doi: 10.21037/atm-20-3542.
The clinical outcome of mitral valve repair (MVP) is considerably more favorable than that of mitral valve replacement (MVR) in patients with degenerative mitral disease. However, rheumatic heart disease (RHD) is still the predominant cause of mitral valve surgery in developing countries and the advantages of MVP in RHD have still not been definitely proven. The aim of this meta-analysis was thus to evaluate the suitability of MVP in patients with RHD. Considering the difference between mechanical and biological valves, we distinguished them from each other and compared them with MVP individually.
A comparison of clinical outcomes of MVP and MVR in patients with RHD was performed based on clinical trial data. Relevant articles published from January 1, 1990 until March 1, 2020 were identified in Pubmed, Cochrane Library, and China National Knowledge Infrastructure database (CNKI). Studies that lacked direct comparisons between MVP and MVR were excluded.
A total of 16 studies with 8659 patients were included in the analysis. The MVP group displayed lower early and long-term mortality, and fewer valve-related events and major adverse events. However, this patient group required more reoperations compared with the MVR group. Similar results were observed after distinguishing between mechanical and bioprosthetic valves to compare MVP with MVR (mech-valves), but no statistically significant difference was identified in the reoperation rate between MVP and MVR (bio-valves). MVP was further associated with increased risk of mitral reoperation in patients undergoing concomitant aortic valve replacement (AVR) surgery but without any improved early and long-term survival.
MVP and MVR are beneficial for patients with RHD. For skilled surgeons, MVP can be performed for some suitable patients with RHD and is preferred for elderly patients or patients with contraindications of anticoagulation. However, MVR is more appropriate when concomitant AVR is needed.
在退行性二尖瓣疾病患者中，二尖瓣修复术（MVP）的临床结果比二尖瓣置换术（MVR）更为有利。然而，风湿性心脏病（RHD）仍是发展中国家二尖瓣手术的主要原因，MVP在RHD中的优势尚未得到明确证实。因此，本荟萃分析的目的是评估MVP在RHD患者中的适用性。考虑到机械瓣膜和生物瓣膜之间的差异，我们将它们区分开来，并分别与MVP进行比较。
基于临床试验数据，对RHD患者中MVP和MVR的临床结果进行比较。在PubMed、Cochrane图书馆和中国知网数据库（CNKI）中检索1990年1月1日至2020年3月1日发表的相关文章。排除缺乏MVP和MVR直接比较的研究。
共有16项研究，8659例患者纳入分析。MVP组显示出较低的早期和长期死亡率，以及较少的瓣膜相关事件和主要不良事件。然而，与MVR组相比，该患者组需要更多的再次手术。在区分机械瓣膜和生物人工瓣膜以比较MVP与MVR（机械瓣膜）后，观察到类似结果，但MVP和MVR（生物瓣膜）之间的再次手术率没有统计学显著差异。在接受同期主动脉瓣置换术（AVR）的患者中，MVP与二尖瓣再次手术风险增加相关，但早期和长期生存率没有任何改善。
MVP和MVR对RHD患者有益。对于技术熟练的外科医生，MVP可用于一些合适的RHD患者，对于老年患者或有抗凝禁忌证的患者更可取。然而，当需要同期AVR时，MVR更合适。
