Mitral Valve Surgery with and Without Mitral Annular Disjunction: A Meta-Analysis

Journal article : Review

Background/objectivesDespite growing awareness of mitral annular disjunction's (MAD) clinical significance, robust data regarding the outcomes of surgical interventions on MAD remain sparse. This meta-analysis aims to systematically evaluate the current evidence on the efficacy and safety of mitral valve (MV) surgery in patients with MAD.MethodsA systematic review was conducted from inception until May 2025 for studies comparing patients undergoing MV surgery with and without MAD and was registered in PROSPERO: CRD42025649821.ResultsPatients with MAD were generally younger (59.3 ± 5.0 vs. 63.4 ± 2.2 years, standardized mean difference: -0.3073), had fewer comorbidities but more complex valve lesions (41.0% vs. 13.7%, risk difference: 0.2627) compared to those without MAD. MV replacement was performed less frequently in the MAD group than in the No-MAD group (risk ratio, RR: 0.690 [95% confidence interval, CI: 0.508; 0.937], p = 0.017), probably related to the significant difference in age between the two groups. The MAD cohort demonstrated a higher incidence of ventricular arrhythmia both after surgery (RR: 7.255 [95%CI: 1.231; 42.763], p = 0.029) and during follow-up (incidence rate ratio, IRR: 2.750 [95%CI: 1.372; 5.512], p = 0.004). Although the MAD group experienced more arrhythmic events over time, this did not translate into a significant difference in overall mortality compared to patients without MAD (IRR: 0.573 [95%CI: 0.072; 4.555], p = 0.599).ConclusionsThis meta-analysis revealed significant baseline differences between the populations. Our findings suggest that patients with MAD remained at significantly higher risk for both postoperative and long-term arrhythmias. These results highlight the need for close arrhythmic surveillance in this population.

Authors: Baudo, M; Cabrucci, F; Di Muro, FM; Magouliotis, DE; Bacchi, B

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: MDPI
• Journal: Journal of Cardiovascular Development and Disease
• Volume: 12
• Issue: 11
• Pages: 436
• Publication date: 2025-11-04
• Acceptance date: 2025-10-31
• DOI: 10.3390/jcdd12110436
• EISSN: 2308-3425
• ISSN: 2308-3425
• Pmid: 41295362
• Language: English
• Keywords: ventricular arrhythmia; Mitral Valve Surgery; Cardiac surgery; Meta-analysis; Mitral Annular Disjunction
• Subtype: Review