Fu Guangguo, Zhou Zhuoming, Huang Suiqing, Chen Guangxian, Liang Mengya, Huang Lin, Wu Zhongkai
Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.
Front Cardiovasc Med. 2021 May 28;8:685746. doi: 10.3389/fcvm.2021.685746. eCollection 2021.
High morbidity and mortality caused by rheumatic heart disease (RHD) are global burdens, especially in low-income and developing countries. Whether mitral valve repair (MVP) benefits RHD patients remains controversial. Thus, we performed a meta-analysis to compare the perioperative and long-term outcomes of MVP and mitral valve replacement (MVR) in RHD patients. A systematic literature search was conducted in major databases, including Embase, PubMed, and the Cochrane Library, until 17 December 2020. Studies comparing MVP and MVR in RHD patients were retained. Outcomes included early mortality, long-term survival, freedom from reoperation, postoperative infective endocarditis, thromboembolic events, hemorrhagic events, and freedom from valve-related adverse events. Eleven studies that met the inclusion criteria were included. Of a total of 5,654 patients, 1,951 underwent MVP, and 3,703 underwent MVR. Patients who undergo MVP can benefit from a higher long-term survival rate (HR 0.72; 95% CI, 0.55-0.95; = 0.020; = 44%), a lower risk of early mortality (RR 0.62; 95% CI, 0.38-1.01; = 0.060; = 42%), and the composite outcomes of valve-related adverse events (HR 0.60; 95% CI, 0.38-0.94; = 0.030; = 25%). However, a higher risk of reoperation was observed in the MVP group (HR 2.60; 95% CI, 1.89-3.57; <0.001; = 4%). Patients who underwent concomitant aortic valve replacement (AVR) in the two groups had comparable long-term survival rates, although the trend still favored MVP. For RHD patients, MVP can reduce early mortality, and improve long-term survival and freedom from valve-related adverse events. However, MVP was associated with a higher risk of reoperation. : https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=228307.
风湿性心脏病（RHD）所致的高发病率和死亡率是全球性负担，在低收入和发展中国家尤为突出。二尖瓣修复术（MVP）对RHD患者是否有益仍存在争议。因此，我们进行了一项荟萃分析，以比较RHD患者中MVP和二尖瓣置换术（MVR）的围手术期及长期结局。在包括Embase、PubMed和Cochrane图书馆在内的主要数据库中进行了系统的文献检索，直至2020年12月17日。纳入比较RHD患者中MVP和MVR的研究。结局包括早期死亡率、长期生存率、再次手术率、术后感染性心内膜炎、血栓栓塞事件、出血事件以及无瓣膜相关不良事件。纳入了11项符合纳入标准的研究。在总共5654例患者中，1951例行MVP，3703例行MVR。接受MVP的患者可从较高的长期生存率（HR 0.72；95%CI，0.55 - 0.95；P = 0.020；I² = 44%）、较低的早期死亡风险（RR 0.62；95%CI，0.38 - 1.01；P = 0.060；I² = 42%）以及瓣膜相关不良事件的综合结局（HR 0.60；95%CI，0.38 - 0.94；P = 0.030；I² = 25%）中获益。然而，MVP组观察到较高的再次手术风险（HR 2.60；95%CI，1.89 - 3.57；P<0.001；I² = 4%）。两组中接受同期主动脉瓣置换术（AVR）的患者长期生存率相当，尽管趋势仍有利于MVP。对于RHD患者，MVP可降低早期死亡率，提高长期生存率并减少瓣膜相关不良事件。然而，MVP与较高的再次手术风险相关。: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=228307
