Nuthalapati Umesh, Bathinapattla Manoj Reddy, Cardoso Rayner Peyser, Jesi Nusrat Jahan, Singh Kanwarmandeep, Moradi Iman, Gostomczyk Karol, Afzal Maham, Omer Moosa Bin, Mian Zorez Rashid, Patel Soham, Sachdeva Pratyush, Malik Muhammad Nauman, Abbas Mohammad, Singh Jugraj, Shafique Muhammad Ashir
Ivano Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.
AIIMS Jodhpur, Jodhpur, India.
Egypt Heart J. 2024 Oct 4;76(1):134. doi: 10.1186/s43044-024-00564-5.
Infective endocarditis (IE) poses significant clinical challenges, often necessitating surgical intervention for improved patient outcomes. The choice between mitral valve repair (MVP) and mitral valve replacement (MVR) is crucial in managing IE. This systematic review and meta-analysis aims to compare the effectiveness of MVP and MVR in treating IE, focusing on outcomes such as postoperative bleeding, mortality, recurrent endocarditis, and stroke.
A comprehensive literature search was conducted following PRISMA guidelines. Studies directly comparing MVP and MVR in IE patients were included. Data extraction and quality assessment were performed, and meta-analysis was conducted using RevMan software. Thirty-two studies involving 82,123 patients were included. MVP was associated with significantly lower rates of postoperative bleeding (OR: 0.58, 95% CI: 0.40-0.84) and reduced long-term mortality (OR: 0.40, 95% CI: 0.32-0.51) compared to MVR. However, MVR showed lower rates of recurrent endocarditis. MVP was also associated with a decreased likelihood of postoperative stroke (OR: 0.52, 95% CI: 0.40-0.68).2, 4 CONCLUSIONS: MVP demonstrates advantages over MVR in reducing postoperative bleeding, long-term mortality, and stroke risk in IE patients. However, individual patient factors and surgical expertise must be considered in treatment decisions. Further research, including randomized controlled trials, is needed to validate these findings and refine treatment algorithms for IE management.
感染性心内膜炎（IE）带来了重大的临床挑战，通常需要进行手术干预以改善患者预后。二尖瓣修复术（MVP）和二尖瓣置换术（MVR）之间的选择对于IE的治疗至关重要。本系统评价和荟萃分析旨在比较MVP和MVR治疗IE的有效性，重点关注术后出血、死亡率、复发性心内膜炎和中风等结局。
按照PRISMA指南进行了全面的文献检索。纳入了直接比较IE患者中MVP和MVR的研究。进行了数据提取和质量评估，并使用RevMan软件进行了荟萃分析。纳入了32项涉及82123例患者的研究。与MVR相比，MVP术后出血率显著更低（比值比：0.58，95%置信区间：0.40-0.84），长期死亡率降低（比值比：0.40，95%置信区间：0.32-0.51）。然而，MVR的复发性心内膜炎发生率更低。MVP术后中风的可能性也降低（比值比：0.52，95%置信区间：0.40-0.68）。
在降低IE患者术后出血、长期死亡率和中风风险方面，MVP显示出优于MVR的优势。然而，治疗决策中必须考虑个体患者因素和手术专业知识。需要进一步的研究，包括随机对照试验，以验证这些发现并完善IE管理的治疗算法。
