Mitral Valve Repair for Anterior/Bileaflet Versus Posterior Leaflet Degenerative Mitral Valve Disease: A Systematic Review and Metaanalysis

Mitral valve repair (MVr) secondary to degenerative anterior/bi-leaflet mitral valve disease is more challenging than posterior leaflet repair. However, conclusive evidence is needed to make decisions based on the outcomes rather than technical difficulties. This meta-analysis compares anterior/bi-leaflet MVr with isolated posterior leaflet repair in patients with mitral regurgitation (MR) due to degenerative mitral valve disease. The outcomes of interest were long-term (>= 5 years) survival and freedom from re-operation and moderate-to-severe MR. Meta-analysis of 10 studies showed that there was no significant difference in long-term survival (risk ratio, RR: 1.00; 95% confidence interval, 95% CI 0.96-1.04), freedom from moderate-to-severe MR (RR: 0.95; 95% CI 0.87-1.03), and freedom from re-operation (RR: 0.96; 95% CI 0.90-1.02) between anterior/bi-leaflet MVr and posterior leaflet repair. As outcomes of anterior/bilateral repair were comparable with those of isolated posterior leaflet repair, our findings do not support the inclination towards replacement over repair for MR caused by anterior/bilateral degenerative mitral disease.

Automated summary

This meta-analysis compares the long-term outcomes of anterior/bi-leaflet mitral valve repair and isolated posterior leaflet repair in patients with mitral regurgitation due to degenerative mitral valve disease. The results showed no significant difference in long-term survival, freedom from moderate-to-severe MR, and freedom from re-operation between anterior/bi-leaflet repair and posterior leaflet repair.