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Repair or replace ischemic mitral regurgitation during coronary artery bypass grafting? A meta-analysis

Yushu Wang1, Xiuli Shi1, Meiqin Wen1

  • 1Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.

Journal of Cardiothoracic Surgery
|September 3, 2016
PubMed

Insights

Mitral valve replacement during coronary artery bypass grafting (CABG) for ischemic mitral regurgitation shows lower recurrence rates. Survival and reoperation rates were similar between repair and replacement groups in this meta-analysis.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Outcomes
  • Mitral Valve Disease

Background:

  • Optimal surgical management for chronic ischemic mitral regurgitation (IMR) during coronary artery bypass grafting (CABG) remains debated.
  • This meta-analysis compares clinical outcomes of mitral valve repair versus replacement in IMR patients undergoing CABG.

Purpose of the Study:

  • To meta-analyze and compare the clinical outcomes of mitral valve repair and replacement in patients with chronic ischemic mitral regurgitation undergoing CABG.

Main Methods:

  • A comprehensive literature search was conducted across major databases (PubMed, Embase, Ovid Medline, Cochrane Library).
  • Keywords included "ischemic mitral regurgitation," "mitral valve repair," "mitral valve replacement," and "coronary artery bypass grafting."
  • Primary outcomes were operative and late mortality; secondary outcomes included regurgitation recurrence and reoperation rates.

Main Results:

  • Eleven studies with 1750 patients were included; 60.4% underwent mitral valve repair.
  • No significant differences were observed in operative mortality (OR 0.65, p=0.05) or late mortality (HR 0.87, p=0.31).
  • Regurgitation recurrence was significantly lower following mitral valve replacement (OR 5.41, p<0.001), while reoperation rates showed no significant difference (OR 1.47, p=0.12).

Conclusions:

  • Mitral valve replacement in chronic IMR patients undergoing CABG is associated with reduced mitral regurgitation recurrence.
  • No significant differences in survival or reoperation rates were found between mitral valve repair and replacement.
Abstract

Keywords:
Coronary artery bypass graftingIschemic mitral regurgitationMeta-analysisMitral valve repairMitral valve replacement

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