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Should the mitral valve be repaired for moderate ischemic mitral regurgitation at the time of revascularization surgery? A Systematic Review and Meta-Analysis

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posted on 26.11.2018, 11:45 by Mohammad Y. Salmasi, Amer Harky, Mohammed F. Chowdhury, Ali Abdelnour, Anastasia Benjafield, Farah Suker, Stephanie J. Hubbard, Hunaid A. Vohra
Background: Ischemic mitral regurgitation (IMR) is associated with increased mortality and recurrent congestive heart failure following coronary artery bypass graft (CABG) surgery. While mitral surgery should be undertaken for severe MR during CABG, the treatment of moderate IMR remains controversial. We conducted a meta‐analysis to determine the outcomes of CABG alone and combine with mitral valve repair (MVr) in moderate IMR. Methods: A literature search was conducted by Pubmed, Ovid, and Embase, which included 643 articles. Eleven studies (seven observational studies and four randomized controlled trials) with a total of 1406 patients were included (CABG alone = 864 and CABG plus MVr = 542). Results: There was no difference in operative mortality (odds ratio 1.56, 95% confidence interval [CI] 0.92‐2.71) or long‐term survival at 1 or 5 years (hazard ratio 0.98, 95%CI 0.71‐1.35, P = 0.49) between the two groups, and little evidence of heterogeneity was found in the studies (I2 = 0.0, P = 0.562). There was significantly greater improvement in MR grade (weighted mean difference [WMD] −1.15, 95%CI −1.67 to −0.064, P = < 0.001) and left ventricular systolic diameter (WMD −3.02, 95%CI −4.85 to −1.18, P = 0.001) following CABG and MVr compared to CABG alone. No difference in postoperative functional class or ejection fraction was found. Conclusions: Our results show that in the presence of moderate IMR, adding MVr to revascularization reduces MR grade on follow‐up echocardiography and promotes ventricular remodeling, with no improvement in long‐term survival or functional class.

History

Citation

Journal of Cardiac Surgery, 2018, 33 (7), pp 374-384

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Health Sciences

Version

AM (Accepted Manuscript)

Published in

Journal of Cardiac Surgery

Publisher

Wiley

issn

0886-0440

eissn

1540-8191

Acceptance date

04/05/2018

Copyright date

2018

Available date

10/06/2019

Publisher version

https://onlinelibrary.wiley.com/doi/full/10.1111/jocs.13722

Notes

The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.

Language

en

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