Short- and Medium-Term Effects of Combined Mitral Valve Surgery and Coronary Artery Bypass Grafting Versus Coronary Artery Bypass Grafting Alone for Patients with Moderate Ischemic Mitral Regurgitation: A Meta-Analysis

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• 作者：Liangshan Wang ; MD ; Bo Li ; MD ; Changcheng Liu ; MD ; Tianhua Rong ; MD ; Yang Yu ; PhD ; Chengxiong Gu ; MD ; ^{anzhengu@sina.com}
• 关键词：coronary artery bypass grafting ; mitral valve surgery ; potential benefit ; risk ; moderate ischemic mitral regurgitation ; meta-analysis
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：30
• 期：6
• 页码：1578-1586
• 全文大小：1682 K
• 卷排序：30

文摘

To investigate the short- and medium-term effects of combined mitral valve surgery (MVS) and coronary artery bypass grafting (CABG) versus CABG alone for patients with moderate ischemic mitral regurgitation (IMR).DesignMeta-analysis of 4 randomized controlled trials (RCTs) and 5 observational studies.SettingHospitals that perform cardiac surgery.ParticipantsThe study included 1,256 cardiac surgery patients from 4 RCTs and 5 observational studies.InterventionsNone.Measurements and Main ResultsFour RCTs and 5 observational studies were included in this meta-analysis. Concomitant MVS significantly reduced the residual rate of postoperative IMR (moderate or severe) (RCTs: OR –0.32, 95% confidence interval [CI] –0.58 to –0.07, p = 0.01; observational studies: OR –0.23, 95% CI –0.34 to –0.12, p<0.0001) and the proportion of surviving patients with New York Heart Association class III or IV (RCTs: OR 0.45, 95% CI 0.31-1.8, p = 0.008), but did not improve early mortality (RCTs: OR 0.91, 95% CI 0.30-2.74, p = 0.87; observational studies: OR 1.63, 95% CI 0.88-3.05, p = 0.12) or medium-term mortality (RCTs: OR 0.89, 95% CI 0.46-1.74, p = 0.73; observational studies: OR 0.94, 95% CI 0.65-1.37, p = 0.48) compared with CABG alone. Moreover, adding the mitral valve procedure did not significantly increase the risk of stroke (RCTs: OR 2.27, 95% CI 0.73-7.08, p = 0.16; observational studies: OR 0.55, 95% CI 0.10-3.06, p = 0.50).ConclusionsThe potential benefits of combined MVS and CABG could outweigh its risks for patients with moderate IMR.