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A Network Meta-analysis Comparing Effects of Various Materials for Annuloplasty in Patients with Mitral Regurgitation
Kan Wang, Rui Li, Cai Cheng.
Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong U, Wuhan, China.

BACKGROUND: Mitral valve regurgitation has long been a question of great interest in cardiovascular disease. The main disadvantage of mitral valve regurgitation is a decline in heart function. And mitral valve repair is favorable in the treatment of choice for mitral valve regurgitation.However, there has been no clear evidence that which valve material is the best choice to mitral valve repair. METHODS: PubMed, Embase, Cochrane library and Web of science were searched to identify relevant primary case-control studies published between 1995 and 2019. Cochrane Risk of Bias tools were used to quality appraise the studies. Three researchers independently screened the literature and extracted the data. Traditional meta-analysis and network meta-analysis were performed by Review Manager 5.3, ADDIS and R software 3.6.2. The funnel plot was used to assess the publication bias. Inconsistency between direct and indirect comparisons was also not significant.RESULTS: We identified total of 1437 articles through database searching, but only 12 random-trials with 5 different types of materials were included in the data extraction and quality assessment stage. The traditional meta-analysis revealed that mortality, treatment success and re-operation was not associated with the materials of rings. We only found the rigid ring is associated with reduced recurrent mitral regurgitation rates and has significant difference(P<0.05). The network meta-analysis and the ranking showed that semi-flexible ring ranks first in mortality, recurrence rate and secondary surgery rate. CONCLUSIONS: Network meta-analysis shows that among five rings, semi-flexible ring is the worst materials for mitral valve repair. And we recommended using semi-rigid ring that has an acceptable mortality, recurrence rate and secondary surgery rate (Second rank for all good outcomes) as the most suitable material for mitral valve repair.LEGEND: Network of comparisons of different materials for mitral valve repair


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