COMPARATIVE EFFICACY OF SUBVALVULAR PROCEDURE VERSUS ISOLATED ANNULOPLASTY IN MITRAL VALVE REPAIR: A META- ANALYSIS ON MORTALITY AND MITRAL REGURGITATION RECURRENCE

Introduction: The aim of this meta-analysis is to identify if adding subvalvular procedure (SVP) in mitral valve repair in functional mitral regurgitation (MR) improves the result in contrast to isolated annuloplasty (AN). Methods: A literature search in PubMed, Cochrane Library, and ClinicalTrials.gov covered January 2010 to August 2024, focusing on ischemic and functional mitral disease, mitral valve repair, and surgical techniques. Inclusion criteria followed PRISMA guidelines with the primary objective to compare early and late mortality and MR recurrence. Screening involved independent assessments with a PRISMA flowchart. Bias was evaluated with ROBINS-E, quality with the modified Newcastle-Ottawa scale, and heterogeneity with I 2 statistics, controlling for high-quality studies only as sensitivity analysis. Results: A total of 1904 papers were found with a traditional research and 164 with the Umbrella research. After screening, 14 studies were included, for a total of 999 patients, of which 519 (51.95%) underwent AN and 480 (48.05%) underwent adjunctive SVP. There was no difference in early mortality (OR 0.91, CI95% 0.46-1.8, p=0.87, I2=0), in late mortality (OR 1.24, CI95% -0.17-0.60, p=0.28, I2=0) nor post operative complications (OR 0.7, CI95% 0.35- 1.39, p=0.3035, I2= 70.63) but in the SVP group there was a significant reduction in MR recurrence with OR 0.48, CI95% 0.33-0.71, p = 0.0002, I2=0. No publication bias was found, even if 9 studies (64.29%) showed high risk of bias with ROBINS-E tool. Conclusions: SVP are associated with lower rates of MR recurrence, without modifying mortality nor immediate post-operative complications.