Comentale Giuseppe, Ahmadi-Hadad Armia, Moldon Harvey James, Carbone Andreina, Manzo Rachele, Calanni Macchio Concetta, Damiano Anna, Bossone Eduardo, Esposito Giovanni, Pilato Emanuele
Division of Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples Italy.
Division of Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples Italy.
Am J Cardiol. 2025 Jul 1;246:33-42. doi: 10.1016/j.amjcard.2025.03.004. Epub 2025 Mar 18.
Mitral valve (MV) repair for infective endocarditis (IE) has proven to be a good and safe option, but current trends favor replacement; the available data, in addition, don't allow to reach a general consensus on the preferred first-line approach. The present metanalysis, aimed to compare short- and long-term outcomes between MV repair (MVRep) and MV replacement (MVR) in patients with IE. A search of PubMed was conducted on 30th August 2024, yielding 120 results. (PROSPERO CRD: CRD42023490612). Four additional suitable studies were identified and added from Embase and Medline (via Ovid). Statistical analyses were performed using RStudio, SPSS, and RevMan. Pseudoindividual patient data were extracted from Kaplan-Meier curves by converting the graphical plots into raw data coordinates through WebPlotDigitizer. A total of 21 studies were eligible for inclusion. The 16-year reconstructed analysis revealed that patients undergoing MVRep have higher survival compared to the MVR group (HR: 1.41, 95% Cl: 1.30-1.53, p < 0.001). Moreover, IE recurrence was significantly lower in MVRep (95% CI, RR:0.46, 12 = 41%, p = 0.03). Reoperation rates, however, were similar between MVRep and MVR (95% CI, RR: 0.78, 12 = 0%, p = 0.27). In-hospital mortality was similar between the groups (95% CI, RR:0.40, 12 = 34%, p = 0.07). In conclusion, MV repair should be favored over replacement in IE when there is no evidence of local extension of the infections and if valve leaflets have not degenerated. This approach is associated with improved overall survival and a reduced risk of IE recurrence, making it particularly advantageous for younger patients.
二尖瓣（MV）修复术治疗感染性心内膜炎（IE）已被证明是一种良好且安全的选择，但目前的趋势倾向于瓣膜置换；此外，现有数据无法就首选的一线治疗方法达成普遍共识。本荟萃分析旨在比较IE患者中MV修复术（MVRep）和MV置换术（MVR）的短期和长期结局。于2024年8月30日在PubMed上进行检索，获得120条结果。（国际前瞻性系统评价注册库编号：CRD42023490612）。从Embase和Medline（通过Ovid）中又识别并添加了四项合适的研究。使用RStudio、SPSS和RevMan进行统计分析。通过WebPlotDigitizer将图形转换为原始数据坐标，从Kaplan-Meier曲线中提取伪个体患者数据。共有21项研究符合纳入标准。16年的重构分析显示，与MVR组相比，接受MVRep的患者生存率更高（风险比：1.41，95%置信区间：1.30 - 1.53，p < 0.001）。此外，MVRep组的IE复发率显著更低（95%置信区间，风险比：0.46，I² = 41%，p = 0.03）。然而，MVRep和MVR之间的再次手术率相似（95%置信区间，风险比：0.78，I² = 0%，p = 0.27）。两组的住院死亡率相似（95%置信区间，风险比：0.40，I² = 34%，p = 0.07）。总之，在没有感染局部扩展证据且瓣膜小叶未退化的IE患者中，应优先选择MV修复术而非置换术。这种方法与总体生存率提高和IE复发风险降低相关，对年轻患者尤其有利。
