Mitral valve repair surgery as an alternative to mitral valve replacement evaluated in Spain

In the second half of December 2022, the Basque Office for Health Technology Assessment (OSTEBA) released a report aiming to evaluate mitral valve repair surgery as an alternative to mitral valve replacement.

The following key conclusions were provided:

• For primary mitral insufficiency:
  • The analyzed scientific evidence described 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 was observed across all age groups;
  • With the exception of one study, a lower rate of reoperation was also described in patients who received mitral valve repair surgery compared to replacement;
  • No studies have been analyzed that compared the results depending on the technique of mitral valve repair;
• For secondary mitral insufficiency:
  • The scientific evidence was insufficient to support a robust recommendation concerning valve repair versus replacement in secondary mitral insufficiency;
  • The results on the rate of reoperation were contradictory;
  • The only consistent result was the rate of admissions for heart failure during follow-up, which was less in the replacement group than in the repair group (in all considered studies);
• According to the results of the study analyzed, there are indications that mitral valve repair surgery may be cost-effective in the short term (two years) but not in the long term (ten years), where the most cost-effective option is replacement surgery. However, no clear conclusions can be drawn concerning whether mitral valve repair is more cost-effective than mitral valve replacement due to the scarce evidence found in the economic evaluation studies.

The full details in Spanish can be found here.

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