Valve Repair Versus Valve Replacement: Current Evidence and Long-Term Outcomes – A Systematic Review

Background: Mitral valve disease remains a leading indication for cardiac surgery worldwide. Surgical approaches include mitral valve repair (MVr) and mitral valve replacement (MVR) , with ongoing debate regarding their relative long-term outcomes [1,2]. Objective: This systematic review aims to compare MVr and MVR in adults regarding operative mortality, long-term survival, reoperation rates, thromboembolic events, endocarditis, and left ventricular function . Methods: Following PRISMA 2020 guidelines , a comprehensive search was conducted in PubMed, Embase, Scopus, Web of Science, and the Cochrane Library for studies published between January 2015 and October 2025 [3–5]. Randomized controlled trials (RCTs), cohort studies, and meta-analyses comparing MVr and MVR were included. Data were extracted by two independent reviewers and analyzed qualitatively and quantitatively. Results: A total of 42 studies comprising 68,000 patients were included. MVr was associated with significantly lower operative mortality (2.3% vs 5.7%), improved long-term survival (10-year survival 72% vs 58%), superior preservation of left ventricular function, and reduced thromboembolic complications compared to MVR [6–10]. Reoperation rates were slightly higher after repair, primarily due to recurrent regurgitation in complex or rheumatic pathology. Conclusions: Mitral valve repair should be the preferred surgical approach whenever feasible due to superior early and long-term outcomes. MVR remains indicated in cases of advanced rheumatic disease, severe calcification, or complex valve pathology. Future research should focus on minimally invasive and robotic techniques , as well as improving repair durability in non-degenerative disease [11–15].