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Thorac Cardiovasc Surg 2017; 65(06): 447-456
DOI: 10.1055/s-0036-1598012
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Surgical Repair of Moderate Ischemic Mitral Regurgitation—A Systematic Review and Meta-analysis

Mahesh Anantha Narayanan
1   Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, United States
,
Saurabh Aggarwal
2   Division of Cardiology, CHI Health Creighton University Medical Center, Omaha, Nebraska, United States
,
Yogesh N. V. Reddy
3   Division of Cardiovascular Sciences, Mayo Clinic, Rochester, Minnesota, United States
,
Venkata M. Alla
2   Division of Cardiology, CHI Health Creighton University Medical Center, Omaha, Nebraska, United States
,
Janani Baskaran
1   Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, United States
,
Arun Kanmanthareddy
2   Division of Cardiology, CHI Health Creighton University Medical Center, Omaha, Nebraska, United States
,
Rakesh M. Suri
4   Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, United States
› Author Affiliations
Further Information

Publication History

11 September 2016

06 November 2016

Publication Date:
21 January 2017 (online)

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Abstract

Introduction Moderate mitral regurgitation (MR) of ischemic etiology has been associated with worse outcomes after coronary artery bypass grafting (CABG). Studies comparing concomitant mitral valve replacement/repair (MVR/Re) with CABG and standalone CABG have reported conflicting results. We performed a systematic review and meta-analysis of the published literature.

Patients and Methods We searched using PubMed, Cochrane, EMBASE, CINAHL, and Google scholar databases from January 1960 to June 2016 for clinical trials comparing CABG to CABG + MVR/Re for moderate MR. Pooled risk ratio or mean difference (MD) with 95% confidence intervals (CI) for individual outcomes were calculated using random effects model and heterogeneity was assessed using Cochrane's Q-statistic.

Results A total of 11 studies were included. Mean follow-up was 35.3 months. All-cause mortality (Mantel–Haenszel [MH] risk ratio [RR]: 0.96, 95% CI: 0.75–1.24, p = 0.775), early mortality (MH RR: 0.65, 95% CI: 0.39–1.07, p = 0.092), and stroke rates (MH RR 0.65, 95% CI: 0.21–2.03, p = 0.464) were similar between CABG and CABG + MVR/Re groups. Adverse event at follow-up was lower with CABG (MH RR: 0.90, 95% CI: 0.61–1.32, p = 0.584). MD of change from baseline in left ventricular (LV) end-systolic dimension (MD: − 2.50, 95% CI: − 5.21 to − 0.21, p = 0.071) and LV ejection fraction (MD: 0.48, 95% CI: − 2.48 to 3.44, p = 0.750) were not significantly different between the groups. Incidence of moderate MR (MH RR: 3.24, 95% CI: 1.79–5.89, p < 0.001) was higher in the CABG only group.

Conclusion Addition of MVR/Re to CABG in patients with moderate ischemic MR did not result in improvement in early or overall mortality, stroke risk, or intermediate markers of LV function when compared with CABG alone.

Keywords

mitral valve insufficiency - coronary artery bypass grafting - moderate mitral regurgitation - coronary artery disease - mitral valve repair

Note

All authors had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. We would like to thank Dr. Aryan Mooss for his expert opinion. We would like to acknowledge Baskaran Krishnamoorthy for reviewing the article for English language, spelling, and grammar corrections.


Supplementary Material

 

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