Key result
Coronary artery bypass grafting alone significantly reduced early mortality compared to CABG combined with mitral valve repair (RR 0.47) in patients with moderate ischemic mitral regurgitation.
Why the study?
Clinical outcomes between CABG alone and CABG with mitral valve repair in patients with moderate ischemic mitral regurgitation remained to be compared.
Does concomitant mitral valve repair during CABG improve clinical outcomes compared to CABG alone in patients with moderate ischemic mitral regurgitation?
Meta-Analysis (n=3,006)
Does concomitant mitral valve repair during CABG improve clinical outcomes compared to CABG alone in patients with moderate ischemic mitral regurgitation?
Relative Risk: 0.47 (95% CI 0.31–0.7)
Concomitant mitral valve repair during CABG for moderate ischemic mitral regurgitation does not improve long-term survival and is associated with higher early mortality compared to CABG alone, despite some improvements in heart failure symptoms.
CABG alone may reduce early mortality in moderate ischemic MR; challenges routine addition of mitral repair.
The aim of this meta-analysis was to compare clinical outcomes between those who underwent coronary artery bypass grafting (CABG) alone and CABG with mitral valve repair (MVR) in patients with moderate ischemic mitral regurgitation. The present study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two authors performed a comprehensive search of international databases, including PubMed, EMBASE, and the Cochrane Library, for relevant studies published from inception to March 1, 2023. The search was performed again before the submission of the manuscript on March 20, 2023. Primary outcomes assessed in the present meta-analysis included early mortality and long-term mortality. Secondary outcomes assessed in the present meta-analysis included change in New York Heart Association (NYHA) score from baseline, change in ejection fraction (EF) from baseline (%), and major cardiovascular events (MACE). A total of 13 studies were included in the present meta-analysis. Out of 13 included studies, four were randomized control trials (RCTs) and nine were retrospective cohort studies. The pooled analysis showed that early mortality was significantly lower in patients in the CABG group compared to the CABG+MVR group (risk ratio [RR]: 0.47, 95% confidence interval [CI]: 0.31, 0.70). Long-term mortality was also lower in patients who underwent CABG compared to patients in the CABG+MVR group. However, the difference was statistically insignificant (RR: 0.88, 95% CI: 0.77, 1.02). No significant differences were reported in the EF score between patients who underwent CABG and patients who underwent CABG plus MVR (mean difference [MD]: 0.40, 95% CI: -1.90, 2.69). NYHA score was significantly lower in patients in the CABG+repair group compared to the CABG alone group (MD: 0.39, 95% CI: 0.06, 0.72). In conclusion, our meta-analysis suggests that concomitant MVR during CABG may not improve clinical outcomes in patients with moderate ischemic mitral regurgitation. Further clinical trials are needed to investigate this intervention in more detail.
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Sameer et al. (2023) conducted a meta-analysis in Moderate ischemic mitral regurgitation (n=3,006). Coronary artery bypass grafting (CABG) alone vs. Coronary artery bypass grafting combined with mitral valve repair (CABG+MVR) was evaluated on Early mortality (RR 0.47, 95% CI 0.31, 0.70). Coronary artery bypass grafting alone significantly reduced early mortality compared to CABG combined with mitral valve repair (RR 0.47) in patients with moderate ischemic mitral regurgitation.
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