title: Repair or replace ischemic mitral regurgitation during coronary artery bypass grafting? A meta-analysis.
abstract: BACKGROUND
  No agreement has been reached for the best surgical treatment for patients with chronic ischemic mitral regurgitation (IMR) undergoing coronary artery bypass grafting (CABG). Our objective was to meta-analyze the clinical outcomes of repair and replacement.
  
  
  METHODS
  A computerized search was performed using Pubmed, Embase, Ovid medline and Cochrane Library. The search terms "ischemic or ischaemic" and "mitral valve" and "repair or replacement or annuloplasty" and "coronary artery bypass grafting" were entered as MeSH terms and keywords. The primary outcomes were operative mortality and late mortality. Secondary outcomes were 2+ or greater recurrence of mitral regurgitation and reoperation rate.
  
  
  RESULTS
  Eleven studies were eligible for the final meta-analysis. These studies included a total of 1750 patients, 60.4 % of whom received mitral valve repair. All patients underwent concomitant coronary artery bypass graft. No differences were found in operative mortality (summary odds ratio [OR] 0.65; 95 % confidence interval [CI] 0.43-1.00; p = 0.05), late mortality (summary hazard ratio [HR] 0.87; 95 % confidence interval [CI] 0.67-1.14; p = 0.31) and reoperation (summary odds ratio [OR] 1.47; 95 % confidence interval [CI] 0.90-2.38; p = 0.12). Regurgitation recurrence was lower in the replacement group (summary odds ratio [OR] 5.41; 95 % confidence interval [CI] 3.12-9.38; p < 0.001).
  
  
  CONCLUSIONS
  In patients with chronic ischemic mitral regurgitation during CABG, mitral valve replacement is associated with lower recurrence of regurgitation. No differences were found regarding survival and reoperation rates.
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Yushu
authors: Y
authors: Wang
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Xiuli
authors: X
authors: Shi
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Meiqin
authors: M
authors: Wen
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors: Yucheng
authors: Y
authors: Chen
authors: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China. zhangqingdoc@126.com.
authors: Qing
authors: Q
authors: Zhang
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D017202:Myocardial Ischemia / Q000601:surgery*; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Coronary artery bypass grafting; Ischemic mitral regurgitation; Meta-analysis; Mitral valve repair; Mitral valve replacement