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Moderate ischemic mitral regurgitation in ischemic heart disease: to operate or not? A meta-analysis

Razan A Alsuayri1, Abdullah K Alassiri2, Ahmed K Awad3

  • 1Batterjee Medical College for Sciences and Technology, Jeddah, Saudi Arabia.

The Journal of Cardiovascular Surgery
|March 6, 2024
PubMed

Insights

For ischemic mitral regurgitation, combining coronary artery bypass grafting (CABG) with mitral valve repair (MVR) showed no significant difference in one-year mortality, stroke, or heart failure hospitalization compared to CABG alone. Personalized treatment is key.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Clinical Research

Background:

  • Ischemic mitral regurgitation is common in patients with coronary artery disease.
  • The decision between coronary artery bypass grafting (CABG) alone or with mitral valve repair for ischemic mitral regurgitation is challenging.
  • Unfavorable outcomes have been linked to ischemic mitral regurgitation post-CABG, but the benefit of concurrent mitral valve repair remains unclear.

Purpose of the Study:

  • To systematically review and meta-analyze clinical outcomes comparing CABG alone versus CABG with mitral valve surgery.
  • To determine if combining CABG with mitral valve repair improves results over CABG alone for ischemic mitral regurgitation.

Main Methods:

  • Systematic review and meta-analysis of six randomized clinical trials.
  • Searched PubMed and Google Scholar for studies comparing CABG versus CABG with mitral valve replacement (MVR).
  • Analyzed data from 852 patients.

Main Results:

  • No significant differences were found between CABG alone and CABG+MVR regarding one-year mortality, stroke, atrial fibrillation, or heart failure hospitalization.
  • A trend towards higher risk of recurrent/residual mitral regurgitation was observed with CABG+MVR (RR=5.42, P=0.065), with significant heterogeneity (I²=66%).
  • No significant heterogeneity was identified for other major outcomes.

Conclusions:

  • CABG alone and CABG+MVR yielded similar clinical results in the studied population.
  • The findings emphasize the necessity for individualized treatment strategies in managing ischemic mitral regurgitation.
  • Patient-specific factors should guide the decision between isolated CABG and combined CABG with MVR.
Abstract

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