The Clinical Evaluation of Rheumatic Mitral Valve Repair

Background and Study Aims: Rheumatic heart disease (RHD) remains a leading cause of mitral valve disease globally, particularly in developing countries, where it poses a significant burden on cardiovascular health. Mitral valve repair (MVP) and replacement are the primary surgical interventions; however, the optimal selection between these procedures remains a subject of ongoing debate. This study aims to systematically review the clinical outcomes of MVP in patients with RHD and compare them with those of mitral valve replacement (MVR), thereby addressing a critical gap in the existing literature. Methods: This study adopts a systematic review methodology in accordance with PRISMA guidelines to screen relevant literature published between 2000 and 2024. The data sources for this study include PubMed, Embase, and the Cochrane Library. The key outcome measures include early mortality (defined as death from any cause within 30 days post-surgery), long-term survival, reoperation rates, and valve-related complications. Results: Five studies encompassing a total of 3,543 patients were analyzed. Compared with MVR, MVP demonstrated a non-significant trend toward lower 30-day mortality (OR 0.74, 95% CI 0.50–1.10; P = 0.14). Long-term survival appeared to favor MVP, with a hazard ratio (HR) of 0.63 (95% CI 0.35–1.11; P = 0.11), although without reaching statistical significance. MVP was associated with a significantly higher risk of reoperation (HR 3.85, 95 % CI 2.18–6.78; P < 0.00001), but a substantially lower incidence of valve-related complications, including thromboembolic events and infective endocarditis (HR 0.36, 95% CI 0.21–0.61; P < 0.001). Conclusions: MVP in patients with RHD reduces early mortality, improves long-term survival, and lowers the incidence of valve-related complications. However, it is associated with a higher risk of reoperation.