Survival Trends of Patients After Mitral Valve Repair for Structural Mitral Regurgitation Compared to the General Population
Bibliographic record
Abstract
All articles of this category (opens in new window) Background: Surgical mitral valve repair (MVr) for structural mitral regurgitation (MR) restores valve function. Individual studies suggest that MVr may normalize life expectancy. We performed a systematic review and a meta-analysis of all studies assessing the impact of MVr for structural MR on survival. Methods: Three databases were assessed searching for studies with survival comparisons to the regional age-matched general population. The primary and single endpoint was long-term mortality. Individual patient data (IPD) were reconstructed from the published Kaplan-Meier curves and was used to calculate overall survival. The Cox proportional hazards regression model was used to assess between-group differences. The hazard ratios (HR) and 95% confidence intervals (CI) of each individual study was calculated. Landmark analysis was performed to check the robustness of the estimated effect. Results: Four studies met the criteria for inclusion in the final analysis. The studies’ follow-up ranged from 10 to 26 years. The pooled Kaplan-Meier curves of reconstructed IPD show that for the entire follow-up, patients who underwent MVr had higher risk of death compared with the general age-matched population (HR: 0.62, 95% CI: 0.53–0.72, p < 0.01). Due to violation of the HR proportions, a landmark analysis was performed splitting the events after 6 years. There was no survival difference between the groups until 6 years after surgery (HR: 0.83, 95% CI, 0.68–1.03, p = 0.09). From 6 to 26 years of follow-up, curves diverged and the MVr group demonstrated significantly higher risk of death compared with the general age-matched population (HR: 0.45, 95% CI, 0.36–0.56, p < 0.01). The individual studies showed that the decrease in survival after 6 years was associated with an increase in return of MR and need of reoperation. Conclusion: MVr for structural MR has the potential to restore life expectancy compared with the general population. However, this effect is limited to the first 6 years after surgery. Risk of death thereafter correlates with the return of severe regurgitation and/or the need for reoperation. Publication History Article published online: 11 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".