Coronary artery bypass grafting (CABG) with Concomitant mitral valve surgery versus Isolated CABG in moderate ischemic mitral valve regurgitation: A meta-analysis
Tóm tắt
Background
Ischemic Mitral Regurgitation (IMR) is associated with increased risks of mortality and heart failure. Unfortunately, the optimal management of moderate ischemic MR remains controversial. Thus, we conducted a meta-analysis to appraise whether moderate IMR should be corrected concomitantly during coronary artery bypass graft (CABG).
Methods
We searched PubMed, Medline and Cochrane Library from its inception until December 31, 2022 for studies that assessed CABG with mitral valve surgery versus CABG alone in patients with moderate ischemic mitral regurgitation. Key terms used were “moderate” + “ischemic or functional” + “mitral regurgitation”, “coronary artery bypass graft” or “CABG” or “revascularization”, “mitral valve surgery (MVS)” or “mitral valve repair (MVr)” or “mitral valve annuloplasty”. The Primary outcome was operative mortality.
Results
Four randomized controlled trials including 507 patients assessing CABG alone (n = 260) versus CABG with mitral valve surgery (n = 247) were included. There was no significant increase in operative mortality (RR, 0.91, 95% CI, 0.31-2.65; p = 0.87), stroke (RR, 2.23; 95% CI, 0.73-6.78; p = 0.16) and perioperative renal failure (RR, 1.32; 95% CI, 0.56-3.10; p = 0.53)in the concomitant MV surgery group. During follow-up, concomitant MV surgery was significantly associated with reduced rates of residual MR (RR, 0.29; 95% CI, 0.17-0.47; p = <0.00001) and NYHA III-IV (RR, 0.51; 95% CI, 0.31-0.85; p = 0.01).
Conclusion
This study suggests that the addition of the MV surgery to CABG as treatment for moderate ischemic mitral valve regurgitation provides more benefit over performing CABG alone, in terms of rate reduction of moderate MR and NYHA class III-IV at follow-up. It was determined that there was no significant risk of perioperative stroke and renal failure in performing concomitant MVR to CABG, however, this single-stage combined procedure did not translate to a reduction in operative mortality.
