title: Surgical Repair of Moderate Ischemic Mitral Regurgitation-A Systematic Review and Meta-analysis.
abstract: IntroductionModerate 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 MethodsWe 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.ResultsA 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.ConclusionAddition 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.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, United States.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Anantha Narayanan
authors.affiliation: Division of Cardiology, CHI Health Creighton University Medical Center, Omaha, Nebraska, United States.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Aggarwal
authors.affiliation: Division of Cardiovascular Sciences, Mayo Clinic, Rochester, Minnesota, United States.
authors.forename: Yogesh N V
authors.initials: YNV
authors.lastname: Reddy
authors.affiliation: Division of Cardiology, CHI Health Creighton University Medical Center, Omaha, Nebraska, United States.
authors.forename: Venkata M
authors.initials: VM
authors.lastname: Alla
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, United States.
authors.forename: Janani
authors.initials: J
authors.lastname: Baskaran
authors.affiliation: Division of Cardiology, CHI Health Creighton University Medical Center, Omaha, Nebraska, United States.
authors.forename: Arun
authors.initials: A
authors.lastname: Kanmanthareddy
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, United States.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left