Key result
MVr cuts 30-day mortality versus other approaches, while CABG plus MVr minimizes renal complications.
Why the study?
The study was conducted to systematically review the efficacy of various surgical approaches for the treatment of ischemic mitral regurgitation.
Do different surgical approaches improve 30-day all-cause mortality and renal complications in patients with moderate-to-severe ischemic mitral regurgitation?
Systematic Review (n=3,111)
Do different surgical approaches improve 30-day all-cause mortality and renal complications in patients with moderate-to-severe ischemic mitral regurgitation?
In a network meta-analysis of patients with ischemic mitral regurgitation, mitral valve repair (MVr) alone or combined with CABG appeared to be the most effective approach for reducing 30-day mortality and renal complications.
Supports MVr (alone or +CABG) to minimize 30-day mortality and renal complications in ischemic MR; extends network meta-analytic evidence over replacement or TEER.
Background: This study aims to systematically review the efficacy of various surgical approaches in the treatment of ischemic mitral regurgitation (IMR). Methods: A comprehensive literature search was conducted using computerized databases, including PubMed, Cochrane Library, Embase, and Web of Science, up to February 2024. In our network meta-analysis, we utilized the Cochrane Handbook tool for quality evaluation, while a consistency model and the odds ratio (OR) were used to compile and analyze the data from the studies included, employing Stata 17.0 software for this purpose. Results: The systematic review included a total of 20 randomized controlled trials (RCTs), which collectively involved 3111 patients and evaluated six different surgical techniques. The network meta-analysis demonstrated that mitral valve repair (MVr) exhibited a significant reduction in 30-day all-cause mortality rates when compared to coronary artery bypass grafting (CABG), mitral valve replacement (MVR), CABG combined with MVR, and transcatheter mitral valve edge-to-edge repair (TEER) using MitraClip. Furthermore, probability ranking analysis suggested that MVr may be the most effective approach in reducing 30-day all-cause mortality, while CABG combined with MVr had significantly fewer renal complications compared to CABG combined with MVR. Probability rankings also indicated that CABG+MVr may be the most effective technique in minimizing renal complications. However, there were no statistically significant differences observed in other outcome measures among the different surgical techniques. Conclusions: Current limited evidence indicates that CABG combined with MVr may be the best surgical approach for patients with IMR. However, these conclusions are tentative and require further confirmation from more additional high-quality studies. INPLASY Registration Number: INPLASY202420049. This study can be accessed at the following detailed address: https://inplasy.com/inplasy-2024-2-0049/, last accessed on February 11, 2024.
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Wei et al. (2024) conducted a systematic review in Ischemic mitral regurgitation (IMR) (n=3,111). Various surgical approaches (MVr, CABG+MVr) vs. CABG, MVR, CABG+MVR, and TEER was evaluated on 30-day all-cause mortality. Mitral valve repair significantly reduced 30-day all-cause mortality compared to CABG, MVR, CABG+MVR, and TEER, while CABG combined with MVr minimized renal complications.
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