PMID- 29050727
OWN - NLM
STAT- MEDLINE
DCOM- 20180918
LR  - 20190117
IS  - 1728-7731 (Electronic)
IS  - 1726-4901 (Linking)
VI  - 81
IP  - 2
DP  - 2018 Feb
TI  - Surgical treatment of active native mitral infective endocarditis: 
      A meta-analysis of current evidence.
PG  - 147-154
LID - S1726-4901(17)30267-8 [pii]
LID - 10.1016/j.jcma.2017.08.017 [doi]
AB  - BACKGROUND: The native mitral lesion of active infective endocarditis implies a 
      poor prognosis and is associated with adverse short- or long-term results without 
      surgical treatment. Both mitral valvuloplasty (MVP) and mitral valve replacement 
      (MVR) have been performed in the treatment of active native mitral infective 
      endocarditis (ANMIE). However, the outcomes of the two approaches remain unclear. 
      The aim of this study was to systematically review the two procedures with 
      mortality and survival as the primary endpoints. METHODS: A systematic review of 
      the literature was conducted to identify all relevant studies with comparative 
      data on MVP versus MVR for the treatment of ANMIE. Information on baseline 
      characteristics of patients, operation method, quality of literature, follow-up, 
      and so forth was abstracted using standardized protocols. Pooled odds ratio (OR) 
      or hazard ratio (HR) was calculated and possible publication bias was tested. 
      RESULTS: Nine comparative observational studies with a total of 633 patients 
      (MVP = 265, MVR = 368) were identified for qualitative assessment, data 
      extraction, and analysis. The summary OR for operative mortality, comparing 
      repair with replacement, was 0.37 (95% CI 0.0.18-0.80; p = 0.0005). Summary 1- 
      and 5-year HRs for event-free survival were 0.43 (95% CI 0.20-0.92; p = 0.03) and 
      0.44 (95% CI 0.25-0.77, p = 0.004), respectively (repair vs. replacement). 
      Summary 1- and 5-year survival HRs were 0.51 (95% CI 0.24-1.08; p = 0.08) and 
      0.55 (95% CI 0.32-0.96; p = 0.004), respectively (repair vs. replacement). No 
      heterogeneity was revealed between studies, and possible publication bias was 
      insignificant. CONCLUSIONS: This meta-analysis suggests that MVP may be 
      associated with superior postoperative survival outcomes compared with MVR. MVP 
      is desirable, if possible, as a durable alternative to replacement. However, we 
      must consider the influence of different patient characteristics and surgeons' 
      preferences on the choice of surgical approach, and additional powered clinical 
      trials will be required to confirm these findings.
CI  - Copyright (c) 2017. Published by Elsevier Taiwan LLC.
FAU - Liu, Jian-Zhou
AU  - Liu JZ
AD  - Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese 
      Academy of Medical Sciences, Beijing, China.
FAU - Li, Xiao-Feng
AU  - Li XF
AD  - Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese 
      Academy of Medical Sciences, Beijing, China.
FAU - Miao, Qi
AU  - Miao Q
AD  - Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese 
      Academy of Medical Sciences, Beijing, China.
FAU - Zhang, Chao-Ji
AU  - Zhang CJ
AD  - Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese 
      Academy of Medical Sciences, Beijing, China. Electronic address: 
      chaojizhang@163.com.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20171016
PL  - Netherlands
TA  - J Chin Med Assoc
JT  - Journal of the Chinese Medical Association : JCMA
JID - 101174817
SB  - IM
MH  - Adult
MH  - Aged
MH  - Endocarditis/mortality/*surgery
MH  - Female
MH  - Heart Valve Prosthesis Implantation/*methods
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/*surgery
OTO - NOTNLM
OT  - Infective endocarditis
OT  - Meta-analysis
OT  - Mitral valve replacement
OT  - Mitral valvuloplasty
EDAT- 2017/10/21 06:00
MHDA- 2018/09/19 06:00
CRDT- 2017/10/21 06:00
PHST- 2016/04/08 00:00 [received]
PHST- 2017/08/05 00:00 [revised]
PHST- 2017/08/09 00:00 [accepted]
PHST- 2017/10/21 06:00 [pubmed]
PHST- 2018/09/19 06:00 [medline]
PHST- 2017/10/21 06:00 [entrez]
AID - S1726-4901(17)30267-8 [pii]
AID - 10.1016/j.jcma.2017.08.017 [doi]
PST - ppublish
SO  - J Chin Med Assoc. 2018 Feb;81(2):147-154. doi: 10.1016/j.jcma.2017.08.017. Epub 
      2017 Oct 16.