P54Meta-analysis of Surgical Repair or Replacement for Rheumatic Mitral Valve Disease

Background: Rheumatic heart disease remains one of the leading causes of valvular heart disease worldwide despite being a preventable condition. Valve repair is superior to replacement in degenerative mitral valve disease, however their relative efficacies is controversial in rheumatic heart disease, in part because of differing and mixed lesions and pathologies, technical challenges, and recurrent events. This meta-analysis compared mitral valve repair and replacement surgery for rheumatic mitral valve disease. Methods: We searched Medline, EMBASE, Cochrane and Scopus databases from January 1980 to June 2016 for original studies reporting outcomes of both mitral valve repair and replacement in rheumatic heart disease. Two authors independently assessed studies for inclusion, followed by data extraction and analysis. Results: The search yielded 933 articles, with 100 full-texts reviewed after initial screening and 17 studies were included for analysis, totalling 1982 mitral valve repairs and 3426 replacements. Pooled rates and odds ratio (95% confidence interval) for operative mortality of repair versus replacement was 3.2% vs 4.3%, 0.68 (0.50-0.92; p = 0.01). Pooled odds ratios (95% confidence interval) were for long-term mortality 0.41 (0.30-0.56; p < 0.001); valve related mortality 0.23 (0.14-0.37; p < 0.001); re-operation 3.02 (1.72-5.31; p < 0.001); and bleeding 0.26 (0.11-0.63; p = 0.003). There was a trend towards lower thromboembolism 0.42 (0.17-1.03; p = 0.06) and no significant difference in endocarditis (p = 0.76) rates during follow-up. Conclusion: Mitral valve repair is associated with reduction in operative and long-term mortality and bleeding, so is recommended to be performed in rheumatic mitral valve disease where feasible, although it does have higher rates of re-operations during follow-up.