Bristol Medical School, Translational Health Science, University of Bristol, Bristol, UK.
Bristol Heart Institute, University Hospital Bristol and Weston NHS Foundation Trust, Bristol, UK.
J Card Surg. 2021 Jul;36(7):2524-2530. doi: 10.1111/jocs.15506. Epub 2021 Mar 30.
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.
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.
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).
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.
二尖瓣（MV）修复术已显示出优异的短期和长期效果，但在老年人群中的优势仍存在争议。我们对比较老年人群中 MV 修复与置换的研究进行了荟萃分析。
对发表于老年患者（≥75 岁）MV 手术的任何研究进行了系统的文献检索。进行了汇总风险比荟萃分析，以评估短期死亡率、术后并发症、手术时间和长期生存率。
共有 9 项回顾性观察研究纳入了定量荟萃分析。汇总荟萃分析显示，MV 修复组的短期死亡率风险降低（风险比 [RR] = 0.41 [0.24-0.71]，p 值 =.005）。尽管没有显著差异，但术后神经并发症有利于修复（RR = 0.49 [0.21-1.11]，p 值 =.07）。虽然没有关于修复复杂性的数据，但两组之间的手术时间（体外循环和主动脉阻断时间）没有差异。修复组的长期生存率更有利（汇总治疗效果为-0.47 [-0.64; -0.29]，p =.005）。
MV 手术对于老年人来说是一种安全有效的方法。MV 修复与置换相比，短期结果更好。修复后的长期生存率显著提高。
