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Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Does Surgical Repair of Moderate Ischemic Mitral Regurgitation Improve Survival? A Systematic Review
Saurav Chatterjee1, Byomesh Tripathi2, Hafeez Ul Hassan Virk2
1Cardiovascular Diseases, Division of Cardiology, Mount Sinai St. Luke's Roosevelt Hospitals, 1111 Amsterdam Avenue, Clark building 3rd floor, New York, NY, 10025, USA. schatterjee@chpnet.org.
Abstract:
Mitral regurgitation (MR) is one of the common complications in myocardial infarction (MI) patients. Almost half of the post MI patients have MR (ischemic MR)(17) which is moderate to severe (grade II-IV). Whether there is a mortality benefit of performing mitral valve repair (MVR) along with coronary artery bypass grafting (CABG) in patients with post MI moderate MR remains inconclusive. Literature search was done from PubMed, Google scholar, Ovid, and Medline databases. Studies which included post MI patients with moderate ischemic MR and reported mortality outcomes of performing CABG and MVR were chosen for the systematic review. Our preliminary literature search identified 194 studies, of which 11 studies met our inclusion criteria. Nine studies showed no survival benefit of performing simultaneous MVR and CABG. One study demonstrated survival benefit of performing CABG plus MVR only in the New York Heart Association (NYHA) class III-IV, and one study suggested survival benefit of performing CABG plus MVR as compared to CABG alone in patient with ischemic MR irrespective of preoperative NYHA functional class. Review of current literature showed mixed results in terms of improvement in functional status but failed to show any survival benefit of performing MVR along with CABG. Limitations of studies include small sample size, difference in baseline demographic variables, and short follow-up period which might influence the outcome of the study. Prospective randomized studies are required to establish clear benefit of performing MVR simultaneously with CABG.
Insights
Mitral regurgitation after myocardial infarction is common. Simultaneous mitral valve repair with coronary artery bypass grafting offers no clear survival benefit for most patients with ischemic mitral regurgitation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Mitral regurgitation (MR) is a frequent complication following myocardial infarction (MI), affecting nearly half of patients with moderate to severe ischemic MR.
- The clinical significance and mortality benefit of concurrent mitral valve repair (MVR) and coronary artery bypass grafting (CABG) in these patients remain uncertain.
Purpose of the Study:
- To systematically review the existing literature to determine the mortality benefit of performing MVR alongside CABG in patients with moderate ischemic MR post-MI.
Main Methods:
- A comprehensive literature search was conducted across PubMed, Google Scholar, Ovid, and Medline databases.
- Studies focusing on post-MI patients with moderate ischemic MR and reporting mortality outcomes for combined CABG and MVR were selected for systematic review.
- Eleven studies met the inclusion criteria from an initial search of 194 identified studies.
Main Results:
- Nine of the included studies found no significant survival advantage for performing simultaneous MVR and CABG.
- One study indicated a survival benefit for CABG plus MVR in patients with New York Heart Association (NYHA) class III-IV.
- Another study suggested a survival benefit for CABG plus MVR compared to CABG alone in ischemic MR patients, regardless of preoperative NYHA class.
Conclusions:
- Current literature presents mixed results regarding functional status improvement but fails to demonstrate a consistent survival benefit for performing MVR concurrently with CABG in post-MI patients with ischemic MR.
- Limitations such as small sample sizes, varied baseline demographics, and short follow-up periods hinder definitive conclusions.
- Further prospective randomized studies are necessary to definitively establish the benefits of simultaneous MVR and CABG.
