Why the study?
Comparative evidence evaluating perioperative characteristics and in-hospital and long-term outcomes of CABG combined with MVR, PCI alone, and PCI combined with TEER for ischemic mitral regurgitation remains limited.
How do CABG + MVR, PCI alone, and PCI + TEER compare regarding perioperative and long-term outcomes in patients with ischemic mitral regurgitation?
How do CABG + MVR, PCI alone, and PCI + TEER compare regarding perioperative and long-term outcomes in patients with ischemic mitral regurgitation?
CABG + MVR offers superior long-term survival compared to PCI alone for ischemic mitral regurgitation, albeit with higher perioperative risks, while PCI + TEER requires further study.
Supports CABG + MVR for long-term survival in ischemic MR despite perioperative risks; extends comparative evidence while leaving PCI + TEER unresolved.
BACKGROUND: Treatments for ischemic mitral regurgitation (IMR) include coronary artery bypass grafting combined with mitral valve replacement (CABG + MVR), percutaneous coronary intervention (PCI) alone, and PCI combined with transcatheter edge-to-edge repair (TEER), but comparative evidence remains limited. We aimed to systematically evaluate perioperative characteristics, in-hospital and long-term outcomes of these strategies. MATERIALS AND METHODS: This PRISMA 2020-compliant systematic review and meta-analysis searched PubMed, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov through 12 November 2024. We included studies reporting outcomes for CABG + MVR, PCI alone, or PCI + TEER in IMR, excluding non-human studies, reviews, case reports, editorials, etc. The endpoints included in-hospital/30-day mortality, long-term mortality, cardiovascular mortality, procedural metrics (cardiopulmonary bypass and cross-clamp time), hospital stay, ICU stay, reoperation, readmission, cerebrovascular events, atrial fibrillation, and low cardiac output syndrome (LCOS). Data were pooled using random-effects models. RESULTS: Thirty-three studies (1 randomized controlled trial, 32 cohorts; n = 3001 patients: 1355 CABG + MVR, 1617 PCI, and 29 PCI + TEER) were analyzed. In-hospital/30-day mortality was 13.8% (95% CI 3.9%-31.7%) for PCI + TEER, 11.8% (95% CI 8.4%-16.5%) for CABG + MVR, and 9.4% (95% CI 7.7%-11.5%) for PCI. Five-year mortality was 37.5% for CABG + MVR vs. 41.8% for PCI. The pooled cardiopulmonary bypass and cross-clamp time for CABG + MVR was 140.2 minutes and 101.0 minutes, respectively. PCI + TEER had shorter hospital stays (17.3 days) than CABG + MVR (22.4 days). Hospital/30-day intra-aortic balloon pump rate was lower in CABG + MVR (7.9%) than PCI + TEER (24.1%). 30-day/in-hospital complications included cerebrovascular events (CABG + MVR: 4.1%, PCI: 0.7%), atrial fibrillation (CABG + MVR: 22.9%), and LCOS (CABG + MVR: 19.6%). One-year readmission and 10-year reoperation rates post-CABG + MVR were 7.4% and 31.1%, respectively. CONCLUSIONS: CABG + MVR demonstrated superior long-term survival and lower cardiovascular mortality than PCI but carried higher perioperative risks and complication rates. PCI + TEER showed shorter hospital stays but insufficient data to assess long-term efficacy. Treatment selection requires balancing comorbidities, surgical risk, and MR severity through multidisciplinary decision-making. Robust comparative trials are needed to optimize IMR management.
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Li et al. (2025) studied this question.
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