Short- and Medium-Term Effects of Combined Mitral Valve Surgery and Coronary Artery Bypass Grafting Versus Coronary Artery Bypass Grafting Alone for Patients with Moderate Ischemic Mitral Regurgitation: A Meta-Analysis.
OBJECTIVE
To investigate the short- and medium-term effects of combined mitral valve surgery (MVS) and coronary artery bypass grafting (CABG) versus CABG alone for patients with moderate ischemic mitral regurgitation (IMR).


METHODS
Meta-analysis of 4 randomized controlled trials (RCTs) and 5 observational studies.


METHODS
Hospitals that perform cardiac surgery.


METHODS
The study included 1,256 cardiac surgery patients from 4 RCTs and 5 observational studies.


METHODS
None.


RESULTS
Four RCTs and 5 observational studies were included in this meta-analysis. Concomitant MVS significantly reduced the residual rate of postoperative IMR (moderate or severe) (RCTs: OR -0.32, 95% confidence interval [CI] -0.58 to -0.07, p = 0.01; observational studies: OR -0.23, 95% CI -0.34 to -0.12, p<0.0001) and the proportion of surviving patients with New York Heart Association class III or IV (RCTs: OR 0.45, 95% CI 0.31-1.8, p = 0.008), but did not improve early mortality (RCTs: OR 0.91, 95% CI 0.30-2.74, p = 0.87; observational studies: OR 1.63, 95% CI 0.88-3.05, p = 0.12) or medium-term mortality (RCTs: OR 0.89, 95% CI 0.46-1.74, p = 0.73; observational studies: OR 0.94, 95% CI 0.65-1.37, p = 0.48) compared with CABG alone. Moreover, adding the mitral valve procedure did not significantly increase the risk of stroke (RCTs: OR 2.27, 95% CI 0.73-7.08, p = 0.16; observational studies: OR 0.55, 95% CI 0.10-3.06, p = 0.50).


CONCLUSIONS
The potential benefits of combined MVS and CABG could outweigh its risks for patients with moderate IMR.
Department of Cardiac Surgery, Beijing An Zhen Hospital of Capital Medical University, Beijing, People's Republic of China.
Liangshan
L
Wang
Department of Cardiac Surgery, Beijing An Zhen Hospital of Capital Medical University, Beijing, People's Republic of China.
Bo
B
Li
Department of Cardiac Surgery, Beijing An Zhen Hospital of Capital Medical University, Beijing, People's Republic of China.
Changcheng
C
Liu
Department of Cardiac Surgery, Beijing An Zhen Hospital of Capital Medical University, Beijing, People's Republic of China.
Tianhua
T
Rong
Department of Cardiac Surgery, Beijing An Zhen Hospital of Capital Medical University, Beijing, People's Republic of China.
Yang
Y
Yu
Department of Cardiac Surgery, Beijing An Zhen Hospital of Capital Medical University, Beijing, People's Republic of China. Electronic address: anzhengu@sina.com.
Chengxiong
C
Gu
D001026:Coronary Artery Bypass / Q000379:methods*; D006801:Humans; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D013995:Time; D016896:Treatment Outcome
coronary artery bypass grafting; meta-analysis; mitral valve surgery; moderate ischemic mitral regurgitation; potential benefit; risk