Mitral valve surgery and coronary artery bypass grafting for moderate-to-severe ischemic mitral regurgitation: Meta-analysis of clinical and echocardiographic outcomes

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 154; no. 1; pp. 127 - 136
• Main Authors: Virk, Sohaib A., BMed/MD, Tian, David H., BMed/MD, Sriravindrarajah, Arunan, BCom (Hons), Dunn, Douglas, BE (Hons), Wolfenden, Hugh D., MBBS, Suri, Rakesh M., MD, DPhil, Munkholm-Larsen, Stine, MD, Cao, Christopher, MBBS, BSc, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2017
• Subjects: CABG; Cardiothoracic Surgery; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - mortality; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - physiopathology; Coronary Artery Disease - surgery; Coronary Vessels - diagnostic imaging; Coronary Vessels - physiopathology; Coronary Vessels - surgery; Echocardiography; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - mortality; Humans; ischemic mitral regurgitation; meta-analysis; Mitral Valve - diagnostic imaging; Mitral Valve - physiopathology; Mitral Valve - surgery; Mitral Valve Annuloplasty - adverse effects; Mitral Valve Annuloplasty - mortality; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - surgery; mitral valve repair; Predictive Value of Tests; Recovery of Function; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome; RR; RCT; mitral valve repair; left ventricular end-systolic volume index; LVEF; HR; left ventricular ejection fraction; New York Heart Association; MD; cardiopulmonary bypass; mitral valve; coronary artery bypass grafting; NYHA; CI; LVESVI; meta-analysis; MV; relative risk; IMR; randomized controlled trial; CPB; ischemic mitral regurgitation; hazard ratio; confidence interval; mean difference; CABG
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2017.03.039

Abstract Objective This meta-analysis was conducted to compare clinical and echocardiographic outcomes following isolated coronary artery bypass grafting (CABG) versus CABG and mitral valve (MV) surgery in patients with moderate-to-severe ischemic mitral regurgitation (IMR). Methods Seven databases were systematically searched to identify relevant studies. For eligibility, studies were required to report on the primary endpoint of perioperative or late mortality. Data were analyzed according to predefined clinical endpoints. Results Four randomized controlled trials (RCTs) (n = 505) and 15 observational studies (OS) (n = 3785) met the criteria for inclusion. Compared with isolated CABG, concomitant CABG and MV surgery was not associated with increased perioperative mortality (RCTs: relative risk [RR] 0.89, 95% confidence interval [CI], 0.26-3.02; OS: RR 1.40, 95% CI, 0.88-2.23). CABG and MV surgery was associated with significantly lower incidence of moderate-to-severe MR at follow-up (RCTs: RR 0.16, 95% CI, 0.04-0.75; OS: RR 0.20, 95% CI, 0.09-0.48). Late mortality was similar between the surgical approaches in RCTs (hazard ratio [HR] 1.20, 95% CI, 0.57-2.53) and OS (HR 0.99, 95% CI, 0.81-1.21). There were no significant differences in echocardiographic outcomes. These results remained consistent in subgroup analyses restricted to patients with strictly moderate IMR. Conclusions In patients with moderate-to-severe IMR, the addition of MV surgery to CABG was not associated with increased perioperative mortality. Although concomitant MV surgery reduced recurrence of moderate-to-severe MR at follow-up, this was not associated with a reduction in late mortality. Larger trials with longer follow-up duration are required to further assess long-term survival and freedom from reintervention.