Mitral Valve Surgery in Patients With Rheumatic Heart Disease: Repair vs. Replacement.
Mitral Valve Surgery in Patients With Rheumatic Heart Disease: Repair vs. Replacement.
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风湿性心脏病患者的二尖瓣手术：修复与置换
DOI：
10.3389/fcvm.2021.685746
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发表时间：
2021
影响因子：
3.6
通讯作者：
Wu Z
中科院分区：
文献类型：
--
作者：
Fu G;Zhou Z;Huang S;Chen G;Liang M;Huang L;Wu Z
背景：风湿性心脏病（RHD）引起的高发病率和死亡率是全球负担，特别是在低收入和发展中国家。二尖瓣修复术 (MVP) 是否有益于 RHD 患者仍存在争议。因此，我们进行了荟萃分析来比较 MVP 和二尖瓣置换术 (MVR) 在 RHD 患者中的围手术期和长期结果。方法和结果：在主要数据库（包括 Embase、PubMed 和 Cochrane 图书馆）中进行了系统的文献检索，检索时间截至 2020 年 12 月 17 日。保留了比较 RHD 患者中 MVP 和 MVR 的研究。结果包括早期死亡率、长期生存、免于再次手术、术后感染性心内膜炎、血栓栓塞事件、出血事件以及免于瓣膜相关不良事件。纳入了十一项符合纳入标准的研究。在总共 5,654 名患者中，1,951 名患者接受了 MVP，3,703 名患者接受了 MVR。接受 MVP 的患者可以获得较高的长期生存率（HR 0.72；95% CI，0.55–0.95；P = 0.020；I2 = 44%）、较低的早期死亡风险（RR 0.62；95% CI，0.38–1.01；P = 0.060；I2 = 42%）以及瓣膜相关不良事件的综合结果。 （HR 0.60；95% CI，0.38–0.94；P = 0.030；I2 = 25%）。然而，MVP 组再次手术的风险较高（HR 2.60；95% CI，1.89–3.57；P<0.001；I2 = 4%）。两组同时接受主动脉瓣置换术 (AVR) 的患者的长期生存率相当，但趋势仍然有利于 MVP。结论：对于 RHD 患者，MVP 可以降低早期死亡率，提高长期生存率并避免发生与瓣膜相关的不良事件。然而，MVP 与较高的再手术风险相关。系统审查注册：https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=228307。
Background: High morbidity and mortality caused by rheumatic heart disease (RHD) are global burdens, especially in low-income and developing countries. Whether mitral valve repair (MVP) benefits RHD patients remains controversial. Thus, we performed a meta-analysis to compare the perioperative and long-term outcomes of MVP and mitral valve replacement (MVR) in RHD patients. Methods and Results: A systematic literature search was conducted in major databases, including Embase, PubMed, and the Cochrane Library, until 17 December 2020. Studies comparing MVP and MVR in RHD patients were retained. Outcomes included early mortality, long-term survival, freedom from reoperation, postoperative infective endocarditis, thromboembolic events, hemorrhagic events, and freedom from valve-related adverse events. Eleven studies that met the inclusion criteria were included. Of a total of 5,654 patients, 1,951 underwent MVP, and 3,703 underwent MVR. Patients who undergo MVP can benefit from a higher long-term survival rate (HR 0.72; 95% CI, 0.55–0.95; P = 0.020; I2 = 44%), a lower risk of early mortality (RR 0.62; 95% CI, 0.38–1.01; P = 0.060; I2 = 42%), and the composite outcomes of valve-related adverse events (HR 0.60; 95% CI, 0.38–0.94; P = 0.030; I2 = 25%). However, a higher risk of reoperation was observed in the MVP group (HR 2.60; 95% CI, 1.89–3.57; P<0.001; I2 = 4%). Patients who underwent concomitant aortic valve replacement (AVR) in the two groups had comparable long-term survival rates, although the trend still favored MVP. Conclusions: For RHD patients, MVP can reduce early mortality, and improve long-term survival and freedom from valve-related adverse events. However, MVP was associated with a higher risk of reoperation. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=228307.