Abstract：
OBJECTIVE: The ideal surgical intervention for secondary mitral regurgitation (SMR), a disease of the left ventricle not the mitral valve itself, is still debated. We performed an updated systematic review and study-level meta-analysis investigating mitral valve repair (MVr) versus mitral valve replacement (MVR) for adult patients with SMR, with or without coronary artery disease (CAD).
METHODS: PubMed, CENTRAL and EMBASE were searched for studies comparing MVr versus MVR. Randomized trial or observational studies were considered eligible. Primary endpoint was long-term mortality for any cause. Kaplan-Meier survival curves were reconstructed and compared with Cox linear regression. Landmark analysis and time-varying hazard ratio (HR) were analyzed. Sensitivity analyses included meta-regression and separate sub-analysis. A random effects model was used.
RESULTS: Twenty-three studies (MVr=3,727 and MVR=2,839) were included. One study was a randomized trial, and 19 studies were adjusted. The mean weighted follow-up was 3.7±2.8 years. MVR was associated with significative greater late mortality (HR=1.26; 95 % CI, 1.14-1.39; P<0.0001) at 10-year follow-up. There was a time-varying trend showing an increased risk of mortality in the first 2 years after MVR (HR=1.38; 95 % CI, 1.21-1.56; P<0.0001), after which this difference dissipated (HR=0.94; 95 % CI, 0.81-1.09; P=0.41). Separate sub-analyses showed comparable long-term mortality in patients with concomitant coronary surgery ≥90 %, left ventricle ejection fraction ≤40 %, and sub-valvular apparatus preservation rate of 100 %.
CONCLUSIONS: Compared to repair, MVR is associated with higher probability of mortality in the first 2 years following surgery, after which the two procedures showed comparable late mortality rate.
METHODS: PubMed, CENTRAL and EMBASE were searched for studies comparing MVr versus MVR. Randomized trial or observational studies were considered eligible. Primary endpoint was long-term mortality for any cause. Kaplan-Meier survival curves were reconstructed and compared with Cox linear regression. Landmark analysis and time-varying hazard ratio (HR) were analyzed. Sensitivity analyses included meta-regression and separate sub-analysis. A random effects model was used.
RESULTS: Twenty-three studies (MVr=3,727 and MVR=2,839) were included. One study was a randomized trial, and 19 studies were adjusted. The mean weighted follow-up was 3.7±2.8 years. MVR was associated with significative greater late mortality (HR=1.26; 95 % CI, 1.14-1.39; P<0.0001) at 10-year follow-up. There was a time-varying trend showing an increased risk of mortality in the first 2 years after MVR (HR=1.38; 95 % CI, 1.21-1.56; P<0.0001), after which this difference dissipated (HR=0.94; 95 % CI, 0.81-1.09; P=0.41). Separate sub-analyses showed comparable long-term mortality in patients with concomitant coronary surgery ≥90 %, left ventricle ejection fraction ≤40 %, and sub-valvular apparatus preservation rate of 100 %.
CONCLUSIONS: Compared to repair, MVR is associated with higher probability of mortality in the first 2 years following surgery, after which the two procedures showed comparable late mortality rate.
摘要：
目的：继发性二尖瓣反流（SMR）的理想手术干预，左心室的疾病，而不是二尖瓣本身的疾病，仍在辩论。我们进行了一项更新的系统评价和研究水平的荟萃分析，调查了成年SMR患者的二尖瓣修复（MVr）与二尖瓣置换术（MVR）。有或没有冠状动脉疾病（CAD）。
方法：PubMed，搜索CENTRAL和EMBASE以比较MVr与MVR的研究。随机试验或观察性研究被认为是合格的。主要终点是任何原因的长期死亡率。重建Kaplan-Meier生存曲线，并与Cox线性回归进行比较。分析了界标分析和时变风险比(HR)。敏感性分析包括荟萃回归和单独的子分析。使用随机效应模型。
结果：纳入了23项研究（MVr=3,727和MVR=2,839）。一项研究是一项随机试验，19项研究进行了调整。平均加权随访时间为3.7±2.8年。在10年随访时，MVR与显著的晚期死亡率相关(HR=1.26；95%CI，1.14-1.39；P<0.0001)。MVR后的前2年有随时间变化的趋势（HR=1.38;95％CI，1.21-1.56;P<0.0001），之后这一差异消失(HR=0.94；95%CI，0.81-1.09；P=0.41)。单独的子分析显示，伴随冠状动脉手术≥90％的患者的长期死亡率相当，左心室射血分数≤40%,瓣膜下器官保存率100%。
结论：与修复相比，MVR在手术后的前2年内与较高的死亡率相关，之后，两种手术显示出相当的晚期死亡率。
方法：PubMed，搜索CENTRAL和EMBASE以比较MVr与MVR的研究。随机试验或观察性研究被认为是合格的。主要终点是任何原因的长期死亡率。重建Kaplan-Meier生存曲线，并与Cox线性回归进行比较。分析了界标分析和时变风险比(HR)。敏感性分析包括荟萃回归和单独的子分析。使用随机效应模型。
结果：纳入了23项研究（MVr=3,727和MVR=2,839）。一项研究是一项随机试验，19项研究进行了调整。平均加权随访时间为3.7±2.8年。在10年随访时，MVR与显著的晚期死亡率相关(HR=1.26；95%CI，1.14-1.39；P<0.0001)。MVR后的前2年有随时间变化的趋势（HR=1.38;95％CI，1.21-1.56;P<0.0001），之后这一差异消失(HR=0.94；95%CI，0.81-1.09；P=0.41)。单独的子分析显示，伴随冠状动脉手术≥90％的患者的长期死亡率相当，左心室射血分数≤40%,瓣膜下器官保存率100%。
结论：与修复相比，MVR在手术后的前2年内与较高的死亡率相关，之后，两种手术显示出相当的晚期死亡率。
