Respect Versus Resect Approaches for Mitral Valve Repair: A Meta-Analysis of Reconstructed Time-to- Event Data

被引:4
作者
Caldonazo, Tulio [1 ]
Sa, Michel Pompeu [2 ,3 ]
Jacquemyn, Xander [4 ]
Eynde, Jef Van den [4 ]
Kirov, Hristo [1 ]
Harik, Lamia [5 ]
Fischer, Johannes [1 ]
Vervoort, Dominique [6 ,7 ]
Bonatti, Johannes [2 ,3 ]
Sultan, Ibrahim [2 ,3 ]
Doenst, Torsten [1 ]
机构
[1] Jena Univ Hosp, Dept Cardiothorac Surg, Jena, Germany
[2] Univ Pittsburgh, Dept Cardiothorac Surg, Pittsburgh, PA USA
[3] Univ Pittsburgh, UPMC Heart & Vasc Inst, Med Ctr, Pittsburgh, PA USA
[4] Dept Cardiovasc Sci, KU Leuven, Leuven, Belgium
[5] Weill Cornell, Dept Med, New York, NY USA
[6] Univ Toronto, Div Cardiac Surg, Toronto, ON, Canada
[7] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada
关键词
mitral valve annuloplasty; mitral valve insufficiency; mitral valve prolapse; mitral valve regurgitation; mitral valve repair; POSTERIOR LEAFLET PROLAPSE; CHORDAL REPLACEMENT; RESTRICTIVE ANNULOPLASTY; REGURGITATION; DISEASE; NEOCHORDAE; MANAGEMENT; STENOSIS;
D O I
10.1016/j.amjcard.2023.12.010
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Mitral valve repair (MVr) has been associated with superior long-term survival and freedom from valve-related complications compared with mitral valve replacement for primary mitral regurgitation (MR). The 2 main approaches for MVr are chordal replacement ("respect approach") and leaflet resection ("resect approach"). We per-formed a systematic review and a meta-analysis using 3 search databases to compare the long-term end points between both approaches. The primary end point was long-term survival. The secondary end points were long-term MR recurrence and reoperation. After reconstruction of time-to-event data for the individual survival analysis, pooled Kaplan -Meier curves for the end points were generated. A total of 14 studies (5,565 patients) were included in the analysis. The respect approach was associated with superior survival compared with the resect approach in the overall sample (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.56 to 0.96, p = 0.024, n = 3,901 patients) but not in the risk-adjusted sample (HR 1.00, 95% CI 0.55 to 1.82, p = 0.991, n = 620 patients). There was no difference between the approaches in the rate of MR recurrence in the overall sample (HR 1.39, 95% CI 0.92 to 2.08, p = 0.116, n = 1,882 patients) or in the risk-adjusted sample (HR 1.62, 95% CI 0.76 to 3.47, p = 0.211, n = 288 patients). The data for reoperation were only available in the overall sample and did not reveal a difference (HR 0.92, 95% CI 0.62 to 1.35, p = 0.663, n = 3,505 patients). In conclusion, the current evidence suggests no difference in long-term mortality, MR recurrence, or reoperation between the resect and respect approaches for MVr after adjusting for patient risk factors. More long-term follow-up data are warranted. (c) 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/) (Am J Cardiol 2024;213:5-11)
引用
收藏
页码:5 / 11
页数:7
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