Original Title: Cirugía reparadora de la válvula mitral como alternativa a la sustitución de la valvular mitral

Authors' objectives: —  To identify, evaluate and synthesise the scientific evidence available on the safety, effectiveness and efficiency of mitral valve repair as an alternative to mitral valve replacement. —  To describe the indications and benefits of mitral valve repair versus mitral replacement in patients with mitral insufficiency, differentiating by age group and including the consequences of the potential postoperative anticoagulation therapy for each age group. —  To describe how the results of these interventions may be affected by the experience of hospitals and surgeons based on the best available evidence. —  To identify, evaluate and synthesise the scientific evidence available on the cost-effectiveness of both techniques.

Authors' results and conclusions: For primary mitral insufficiency, the search failed to identify any randomized clinical trials (RCTs) comparing valve repair versus replacement. It did identify three systematic reviews including observational studies comparing valve repair versus replacement (Jung et al. 2019, Overtchouk et al. 2020 and Fan et al. 2021). For secondary mitral insufficiency, a single RCT was retrieved comparing valve repair versus replacement (Goldstein et al. 2016). A report of results from before this trial was excluded from the review (Acker et al. 2014). Four systematic reviews were identified that included observational studies comparing valve repair versus replacement for secondary mitral insufficiency (Nappi et al. 2020, Takagi et al. 2016, Salmasi et al. 2016, Virk et al. 2015). Additionally, the search retrieved a systematic review by Wang et al. of 10 observational studies including 1807 patients with severe ischaemic mitral insufficiency who underwent heart revascularization surgery with concomitant mitral valve surgery. The review of the evidence on the efficiency of the procedures of interest provided just one article for analysis, a study carried out in the United States in 2018 by Ferket et al. The objective of these researchers was to conduct a cost-effectiveness analysis to assess the economic and health outcomes of valve repair versus replacement. Conclusions —  Primary mitral insufficiency: The scientific evidence analysed describes a strong advantage of valve repair versus replacement in the treatment of severe primary mitral insufficiency, namely, lower early and long-term mortality. This advantage is observed across all age groups. —  Secondary mitral insufficiency: The scientific evidence is insufficient to support a robust recommendation concerning valve repair versus replacement in secondary mitral insufficiency. —  Experience of the hospital and the surgeon: A higher annual volume of mitral valve surgery in hospitals and performed by surgeons is strongly associated with higher rates of repair than replacement. On the other hand, the results regarding mortality are not consistent, making it difficult to reach conclusions and provide recommendations on this matter. —  Costs: From the systematic review of economic evaluation studies, no clear conclusions can be drawn concerning whether mitral valve repair is more cost-effective than mitral valve replacement, due to the paucity of evidence found.

Authors' methods: A systematic review of the literature was conducted with the goal of analysing the evidence on mitral valve repair as an alternative to mitral valve replacement in patients with mitral insufficiency with an indication for surgery, to provide objective information to support decision-making on this type of treatment in clinical practice. The methodology was based on a structured search for systematic reviews (with or without meta-analysis) and economic evaluation studies in pre-selected databases of scientific literature, critical reading of studies and synthesis of results.

Project Status: Completed

Year Published: 2022

URL for published report: https://www.euskadi.eus/contenidos/informacion/osteba_publicacion/eu_def/adjuntos/22-07-OSTEBA_Valvula_Mitral_DEF_NIPO.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>