Rheumatic Mitral Valve Surgery: Repair or Replacement?

Introduction: Rheumatic heart disease remains a public health problem, especially in developing countries. The mitral valve (MV) is the main affected cardiac structure, requiring intervention in many cases. The discussion of which is the best option - repair or replacement - is still a controversy.

Objective: To compare the survival of patients with rheumatic MV submitted to replacement or repair.

Methods: We systematically reviewed the English literature through PubMed®, Literatura Latino-Americana e do Caribe em Ciências da Saúde (or LILACS), Scientific Electronic Library Online (or SciELO), and Google Scholar between January 2021 and February 2022, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (or PRISMA) methodology. Articles with a sample of at least 30 patients who underwent MV replacement or repair were included.

Results: Six studies including 2874 patients were analyzed. Most of the patients were female (2001; 69.6%) with a ratio of 2.3:1. The ages ranged from 11 to 66 years. The mean follow-up varied from six to 106 months. In the MV repair group, mortality was 2.5% (62 of 2473) and reoperation was 3.7% (93 of 2473), while in the MV replacement group, mortality was 8.2% (106 of 1291), and 3.6% (54 of 1475) of the patients required reoperation. The patient's survival was similar (85% for repair and 87% for replacement). The main complications post-MV repair or replacement were stroke (1.8%; 2.5%) and endocarditis (0.5%; 1.3%).

Conclusion: The MV repair had lower mortality and fewer complications compared to MV replacement. Reoperation rate and survival are similar.