Key result
CABG combined with mitral valve surgery did not improve long-term survival compared to CABG alone in patients with ischemic mitral regurgitation (HR 1.34; 95% CI 1.15-1.58; P=0.003).
Why the study?
Does CABG combined with MVRR improve survival compared to CABG alone in patients with ischemic MVR after ACS?
Meta-Analysis (n=3,120)
Does CABG combined with MVRR improve survival compared to CABG alone in patients with ischemic MVR after ACS?
Answers are grounded in this paper and cite their sources.
In patients with ischemic mitral regurgitation, adding mitral valve surgery to CABG does not improve short-term survival and is associated with worse long-term survival compared to CABG alone.
BACKGROUND There is no consensus on whether mitral valve repair or replacement (MVRR) must be performed to treat ischemic mitral regurgitation (MVR) after myocardial infarction. Our objective in this study was to investigate the efficacy of coronary artery bypass grafting (CABG) combined with or without MVRR for the ischemic MVR. MATERIAL AND METHODS An article search was performed in OvidSP, PubMed, Cochrane Library, and Embase. In these articles, researchers compared the efficacy of CABG with or without MVRR in treating patients with ischemic MVR after acute coronary syndrome (ACS). We performed a meta-analysis to compare the differences in the short-term and long-term survival rates of patients treated with CABG only and those treated with both CABG and MVRR. Secondary outcomes were compared with the preoperative and postoperative degree of MVR, left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) class. RESULTS Out of the 1183 studies, we selected only 5 articles. A total of 3120 patients were enrolled; the CABG and MVRR group included 575 patients, while the CABG only group included 2545 patients. Long-term survival was higher in the CABG only group (hazard ratio [HR], 1.34; 95% confidence interval [CI] 1.15-1.58, P=0.003). Hospital mortality was similar in both the groups (odds ratio [OR], 2.54; 95% CI, 0.65-9.95; P=0.18). No differences were found in the degree of residual MVR, the mean of LVESV, LVEF, or NYHA class. CONCLUSIONS In patients with ischemic MVR, the short-term survival rate was similar in both groups. Moreover, there was no significant improvement in the long-term survival rates of patients treated with both CAG and MVRR.
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Zhang et al. (2015) conducted a meta-analysis in Ischemic mitral regurgitation after acute coronary syndrome (n=3,120). CABG combined with mitral valve repair or replacement (MVRR) vs. CABG only was evaluated on Long-term survival (HR 1.34, 95% CI 1.15-1.58, p=0.003). CABG combined with mitral valve surgery did not improve long-term survival compared to CABG alone in patients with ischemic mitral regurgitation (HR 1.34; 95% CI 1.15-1.58; P=0.003).
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