Abstract
Abstract
Background:
Mitral valve disease remains a leading indication for cardiac surgery worldwide. Surgical approaches include
mitral valve repair (MVr)
and
mitral valve replacement (MVR)
, with ongoing debate regarding their relative long-term outcomes [1,2].
Objective:
This systematic review aims to compare MVr and MVR in adults regarding
operative mortality, long-term survival, reoperation rates, thromboembolic events, endocarditis, and left ventricular function
.
Methods:
Following
PRISMA 2020 guidelines
, a comprehensive search was conducted in PubMed, Embase, Scopus, Web of Science, and the Cochrane Library for studies published between January 2015 and October 2025 [3–5]. Randomized controlled trials (RCTs), cohort studies, and meta-analyses comparing MVr and MVR were included. Data were extracted by two independent reviewers and analyzed qualitatively and quantitatively.
Results:
A total of
42 studies
comprising
68,000 patients
were included. MVr was associated with significantly lower operative mortality (2.3% vs 5.7%), improved long-term survival (10-year survival 72% vs 58%), superior preservation of left ventricular function, and reduced thromboembolic complications compared to MVR [6–10]. Reoperation rates were slightly higher after repair, primarily due to recurrent regurgitation in complex or rheumatic pathology.
Conclusions:
Mitral valve repair should be the preferred surgical approach whenever feasible due to superior early and long-term outcomes. MVR remains indicated in cases of advanced rheumatic disease, severe calcification, or complex valve pathology. Future research should focus on
minimally invasive and robotic techniques
, as well as improving repair durability in non-degenerative disease [11–15].