Comparative Outcomes of Mitral Valve Repair Versus Replacement in Infective Endocarditis: A 16-Year Meta-Analysis of Time-to-Event Data From Over 4000 Patients

Mitral valve (MV) repair for infective endocarditis (IE) has proven to be a good and safe option, but current trends favor replacement; the available data, in addition, don't allow to reach a general consensus on the preferred first-line approach. The present metanalysis, aimed to compare short- and long-term outcomes between MV repair (MVRep) and MV replacement (MVR) in patients with IE. A search of PubMed was conducted on 30th August 2024, yielding 120 results. (PROSPERO CRD: CRD42023490612). Four additional suitable studies were identified and added from Embase and Medline (via Ovid). Statistical analyses were performed using RStudio, SPSS, and RevMan. Pseudoindividual patient data were extracted from Kaplan-Meier curves by converting the graphical plots into raw data coordinates through WebPlotDigitizer. A total of 21 studies were eligible for inclusion. The 16-year reconstructed analysis revealed that patients undergoing MVRep have higher survival compared to the MVR group (HR: 1.41, 95% Cl: 1.30–1.53, p < 0.001). Moreover, IE recurrence was significantly lower in MVRep (95% CI, RR:0.46, 12 = 41%, p = 0.03). Reoperation rates, however, were similar between MVRep and MVR (95% CI, RR: 0.78, 12 = 0%, p = 0.27). In-hospital mortality was similar between the groups (95% CI, RR:0.40, 12 = 34%, p = 0.07). In conclusion, MV repair should be favored over replacement in IE when there is no evidence of local extension of the infections and if valve leaflets have not degenerated. This approach is associated with improved overall survival and a reduced risk of IE recurrence, making it particularly advantageous for younger patients.