title: A Systematic Review and Meta-Analysis of Outcomes Following Mitral Valve Surgery in Patients with Significant Functional Mitral Regurgitation and Left Ventricular Dysfunction.
abstract: The surgical correction of functional mitral regurgitation (MR) remains challenging and controversial. The study aim was to systematically review the outcomes of surgical mitral valve repair (MVRpr) and mitral valve replacement (MVR) in patients with significant functional MR and left ventricular (LV) dysfunction.
  
  
  
  A meta-analysis was performed of published data acquired from patients with moderate to severe functional MR and LV ejection fraction (LVEF) <40% who underwent surgical MVRpr or MVR. The data were meta-analyzed across studies using Bayesian hierarchical models when feasible.
  
  
  
  The search yielded 36 observational studies. The pooled proportion of operative mortality following MVRpr was 5% (33 studies; 2,231 patients; 95% credible interval (CrI) 4-7%), while that following MVR was 10% (10 studies; 389 patients; 95% CrI 5-18%). For patients undergoing MVRpr, pooled proportions of postoperative cerebrovascular accidents and renal failure were 2% (11 studies; 750 patients; 95% CrI 1-3%) and 9% (11 studies; 756 patients; 95% CrI 5-16%), respectively. The five-year actuarial survival rates following MVRpr across 12 studies ranged from 47% to 78% (median 66%).
  
  
  
  In selected patients with significant functional MR and LV dysfunction, surgical MVRpr and MVR can be performed with acceptable intermediate operative mortality risks.
authors.affiliation: Department of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Ali
authors.initials: A
authors.lastname: Andalib
authors.affiliation: Department of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Chetrit
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Masha
authors.initials: M
authors.lastname: Eberg
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Kristian B
authors.initials: KB
authors.lastname: Filion
authors.affiliation: Department of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Pascal
authors.initials: P
authors.lastname: Thériault-Lauzier
authors.affiliation: Department of Cardiac Surgery, German Heart Center, Munich, Germany.
authors.forename: Ruediger
authors.initials: R
authors.lastname: Lange
authors.affiliation: Department of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Buithieu
authors.affiliation: Department of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martucci
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Eisenberg
authors.affiliation: Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Steven F
authors.initials: SF
authors.lastname: Bolling
authors.affiliation: Department of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.|Department of Cardiac Surgery, German Heart Center, Munich, Germany. Electronic correspondence: nicolopiazza@mac.com.
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
mesh_terms: D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*