Mitral Valve Replacement Using Subvalvular Apparatus: A Systematic Review and Meta-Analysis


  • Wan Chin Hsieh, MD First Faculty of Medicine, Charles University, Prague, Czech Republic; 2nd Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
  • Anas Aboud, MD Department of Cardiac and Thoracic Vascular Surgery, University of Schleswig-Holstein, Lübeck Campus, Lübeck, Germany
  • Brandon Michael Henry, MD Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
  • Chung Dann Kan, MD, PhD Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
  • Mohamed Omara, MD Department of Thoracic and Cardiovascular Surgery, Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
  • Jaroslav Lindner, MD, PhD 2nd Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic



mitral valve replacement, mitral regurgitation, subvalvular


Background: To assess clinical outcomes among participants undergoing mitral valve replacement with preservation of subvalvular apparatus.

Methods: Electronic databases, including PubMed, Embase, Science Direct, World of Science, Scopus, Biosis, SciElo and Cochrane library, were probed using an extensive search strategy. Studies that reported at least one clinical outcome, such as morbidity, mortality, early 30-day mortality, myocardial failure, survival, late cerebrovascular events, length of stay, or major operative complications (stroke, prolonged ventilation, and reoperation for bleeding, renal failure, and sternal infection) were considered for inclusion. Data was extracted and pooled into a meta-analysis in RevMan (version 5.3) using a random-effects model.

Results: A total of 21 studies with 5,106 participants (age range: 27.3-69.2 years) were included in this meta-analysis. Preservation of the subvalvular apparatus during MVR significantly reduces the risk of long-term mortality (OR: 0.46; 95% CI: 0.33-0.64), but not early mortality (OR: 0.76; 95% CI: 0.12-4.93). No significant difference ejection fraction was observed (SMD: 0.10; 95% CI: -0.44-0.64). Similarly, there was no significant difference in the risk of stroke, renal failure, and pneumonia between C-MVR and in the control group.

Conclusion: MVR with the preservation of subvalvular apparatus improves clinical outcomes, such as long-term mortality, hospital length of stay, pneumonia, and bleeding. There is no significant difference in the risk of stroke, renal failure, or ICU length of stay. However, there is very limited data available with respect to bleeding, sepsis, and
nosocomial infections.


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How to Cite

Hsieh, W. C., Aboud, A., Henry, B. M., Kan, C. D., Omara, M., & Lindner, J. (2020). Mitral Valve Replacement Using Subvalvular Apparatus: A Systematic Review and Meta-Analysis. The Heart Surgery Forum, 23(3), E385-E392.