Meta-analysis of Mitral Valve Repair Versus Replacement for Mitral Valve Infective Endocarditis

Background: Mitral valve repair has superior results to replacement for severe degenerative mitral valve disease, however in the infective endocarditis setting, mixed results have been reported. We compared the outcomes of mitral valve repair and replacement for infective endocarditis in this meta-analysis.Methods: MEDLINE, Embase and Cochrane databases from 1 January 1980 to 31 December 2015 were searched for original studies. Two authors evaluated these studies for inclusion independently, then data were extracted and pooled.Results: A total of 3,976 papers was obtained from the search, 99 full-texts were reviewed, and 13 studies which included both mitral valve repair and replacement patients involving 8,130 patients were included for analyses. Pooled rates and odds ratio (95% confidence interval) for operative mortality of repair versus replacement were 3.7% vs 10.9%, 0.33 (0.26-0.41). Odds ratio for long term mortality at 1-year (n=4) was 0.31 (0.14-0.72), and at 5 years (n=8) was 0.42 (0.25-0.69). Peri-operative stroke rates and odds ratio (n=4) were 2.8% vs 3.8%, 0.75 (0.55-1.00).  Five year recurrent endocarditis and redo-operations (n=6 for both) odds ratios were 0.39 (0.10-1.58) and 0.49 (0.12-2.02) respectively. Similar results were observed when one large study making up 85% of the meta-analysis cohort population was removed.Conclusion: Mitral valve repair is associated with reduction in mortality and stroke, and similar recurrent endocarditis and redo-operation rates compared to mitral valve replacement in mitral valve endocarditis. It is therefore preferred when feasible, similar to surgery for degenerative mitral valve disease.