Mitral valve surgery and coronary artery bypass grafting for moderate-to-severe ischemic mitral regurgitation: meta-analysis of clinical and echocardiographic outcomes

Sohaib A. Virk, David H. Tian, Arunan Sriravindrarajah, Douglas Dunn, Hugh D. Wolfenden, Rakesh M. Suri, Stine Munkholm-Larsen, Christopher Cao*

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    26 Citations (Scopus)

    Abstract

    Objective: This meta-analysis was conducted to compare clinical and echocardiographic outcomes following isolated coronary artery bypass grafting (CABG) versus CABG and mitral valve (MV) surgery in patients with moderate-to-severe ischemic mitral regurgitation (IMR). Methods: Seven databases were systematically searched to identify relevant studies. For eligibility, studies were required to report on the primary endpoint of perioperative or late mortality. Data were analyzed according to predefined clinical endpoints. Results: Four randomized controlled trials (RCTs) (n = 505) and 15 observational studies (OS) (n = 3785) met the criteria for inclusion. Compared with isolated CABG, concomitant CABG and MV surgery was not associated with increased perioperative mortality (RCTs: relative risk [RR] 0.89, 95% confidence interval [CI], 0.26-3.02; OS: RR 1.40, 95% CI, 0.88-2.23). CABG and MV surgery was associated with significantly lower incidence of moderate-to-severe MR at follow-up (RCTs: RR 0.16, 95% CI, 0.04-0.75; OS: RR 0.20, 95% CI, 0.09-0.48). Late mortality was similar between the surgical approaches in RCTs (hazard ratio [HR] 1.20, 95% CI, 0.57-2.53) and OS (HR 0.99, 95% CI, 0.81-1.21). There were no significant differences in echocardiographic outcomes. These results remained consistent in subgroup analyses restricted to patients with strictly moderate IMR. Conclusions: In patients with moderate-to-severe IMR, the addition of MV surgery to CABG was not associated with increased perioperative mortality. Although concomitant MV surgery reduced recurrence of moderate-to-severe MR at follow-up, this was not associated with a reduction in late mortality. Larger trials with longer follow-up duration are required to further assess long-term survival and freedom from reintervention.

    Original languageEnglish
    Pages (from-to)127-136
    Number of pages10
    JournalJournal of Thoracic and Cardiovascular Surgery
    Volume154
    Issue number1
    DOIs
    Publication statusPublished - Jul 2017

    Keywords

    • ischemic mitral regurgitation
    • mitral valve repair
    • CABG
    • meta-analysis

    Fingerprint

    Dive into the research topics of 'Mitral valve surgery and coronary artery bypass grafting for moderate-to-severe ischemic mitral regurgitation: meta-analysis of clinical and echocardiographic outcomes'. Together they form a unique fingerprint.

    Cite this