Key result
Network meta-analysis showed that CABG alone was the most effective treatment for reducing late mortality (SUCRA 70.0%), followed by SPM-r plus RMA with or without CABG (SUCRA 62.4%).
Why the study?
It was unknown whether subvalvular papillary muscle repair plus restrictive mitral valve annuloplasty is the most effective treatment for patients with secondary ischemic mitral regurgitation.
Does subvalvular papillary muscle repair plus restrictive mitral annuloplasty with or without CABG improve clinical outcomes in patients with secondary ischemic mitral regurgitation compared to other surgical strategies?
Meta-Analysis (n=4,458)
Yes
Does subvalvular papillary muscle repair plus restrictive mitral annuloplasty with or without CABG improve clinical outcomes in patients with secondary ischemic mitral regurgitation compared to other surgical strategies?
Absolute Event Rate: 4.4% vs 3.7%
In patients with secondary ischemic mitral regurgitation, combining subvalvular papillary muscle repair with restrictive mitral annuloplasty and CABG is highly effective for reducing early mortality, reoperation, and heart failure readmission, though CABG alone ranked highest for reducing late mortality.
May favor isolated CABG for late survival in ischemic MR; extends network rankings of mitral repair strategies.
This study aims to determine whether subvalvular papillary muscle (PMs) repair (SPM-r) plus restrictive mitral valve (MV) annuloplasty (RMA) is the most effective treatment for patients with secondary ischemic mitral regurgitation. A network meta-analysis was conducted to investigate outcomes of randomized controlled trials, propensity-matched studies, and observational studies, comparing various treatments for secondary ischemic mitral regurgitation. The average follow-up duration for late mortality was 4.4 years. CABG without mitral valve surgery had a late mortality incidence of 3.7%. RMA demonstrated a rate of 6.5%, while RMA + CABG resulted in a rate of 4.1%. SPM-r plus RMA ± CABG and MV-rpl + CABG had rates of 4.4% and 5.1%. SUCRA analysis showed that coronary artery bypass grafting (CABG) was the most effective treatment for reducing late mortality (70.0%). This was followed by SPM-r plus RMA with or without CABG (62.4%). The top strategy for decreasing early death, reoperation, and readmission to the hospital for heart failure is SPM-r plus RMA with or without CABG, based on SUCRA probabilities (84.6%, 85.54%, and 86.3%, respectively). SPM-s plus RMA ± CABG has potential to reduce the risks associated with early mortality, reoperation, and re-hospitalization for heart failure. However, further research is required to substantiate these findings.
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Nappi et al. (2023) conducted a meta-analysis in Secondary ischemic mitral regurgitation (n=4,458). Subvalvular papillary muscle repair (SPM-r) plus restrictive mitral valve annuloplasty (RMA) ± CABG vs. CABG alone, RMA alone, RMA + CABG, or MV replacement + CABG was evaluated on All-cause late mortality. Network meta-analysis showed that CABG alone was the most effective treatment for reducing late mortality (SUCRA 70.0%), followed by SPM-r plus RMA with or without CABG (SUCRA 62.4%).
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