Comparative Outcomes of Mitral Valve Repair Versus Replacement in Infective Endocarditis: A 16-Year Meta-Analysis of Time-to-Event Data From Over 4000 Patients

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2025-03-18 DOI:10.1016/j.amjcard.2025.03.004

Giuseppe Comentale MD, PhD , Armia Ahmadi-Hadad , Harvey James Moldon , Andreina Carbone MD , Rachele Manzo MD , Concetta Calanni Macchio MD , Anna Damiano MD , Eduardo Bossone MD, PhD , Giovanni Esposito MD, PhD , Emanuele Pilato MD, PhD

{"title":"Comparative Outcomes of Mitral Valve Repair Versus Replacement in Infective Endocarditis: A 16-Year Meta-Analysis of Time-to-Event Data From Over 4000 Patients","authors":"Giuseppe Comentale MD, PhD , Armia Ahmadi-Hadad , Harvey James Moldon , Andreina Carbone MD , Rachele Manzo MD , Concetta Calanni Macchio MD , Anna Damiano MD , Eduardo Bossone MD, PhD , Giovanni Esposito MD, PhD , Emanuele Pilato MD, PhD","doi":"10.1016/j.amjcard.2025.03.004","DOIUrl":null,"url":null,"abstract":"<div><div>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<strong>–</strong>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.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"246 ","pages":"Pages 33-42"},"PeriodicalIF":2.3000,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0002914925001365","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

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.

查看原文本刊更多论文

二尖瓣修复与置换术治疗感染性心内膜炎的比较结果：来自4000多例患者的16年时间-事件数据荟萃分析

二尖瓣（MV）修复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置换；此外，现有的数据不能就首选一线治疗方法达成普遍共识。本荟萃分析旨在比较IE患者中压修复（MVRep）和中压置换（MVR）的短期和长期结果。2024年8月3日，PubMed进行了一次搜索，产生了120个结果。（prospero crd: crd42023490612）。从Embase和Medline（通过Ovid）中确定并添加了另外四项合适的研究。采用RStudio、SPSS和RevMan进行统计分析。通过WebPlotDigitizer将图形图转换为原始数据坐标，从Kaplan-Meier曲线中提取假个体患者数据。共有21项研究符合纳入条件。16年的重建分析显示，与MVR组相比，接受MVRep的患者生存率更高(HR: 1.41, 95% Cl: 1.30-1.53, p

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.