Ring annuloplasty plus subvalvular intervention reduced moderate or greater recurrent mitral regurgitation compared to ring annuloplasty alone (RR 0.43; 95% CI 0.27-0.66; P=0.0002).
Meta-Analysis (n=397)
Does combining a ring annuloplasty with a mitral subvalvular intervention improve mitral valve repair durability and LV reverse remodeling compared to ring annuloplasty alone in patients with secondary mitral regurgitation?
Adding a subvalvular intervention to ring annuloplasty for secondary mitral regurgitation significantly reduces recurrent MR and improves LV reverse remodeling compared to ring annuloplasty alone.
Relative Risk: 0.43 (95% CI 0.27–0.66)
p-value: p=0.0002
BACKGROUND: Combining a ring annuloplasty (Ring) with a mitral subvalvular intervention (Ring + subvalvular) in patients with secondary mitral regurgitation (MR) may improve mitral valve (MV) repair durability. However, the outcomes of this strategy compared with a Ring only, have not been clearly defined. METHODS: A systematic review and meta-analysis was performed utilizing randomized controlled and propensity matched studies which compared a Ring + subvalvular versus Ring MV repair for the treatment of secondary MR. Risk ratio (RR), weighted mean difference (MD), and the 95% confidence interval (CI) were calculated by the Mantel-Haenszel and inverse-variance methods, for clinical outcomes and echocardiographic measures of follow-up MR, left ventricular (LV) reverse remodeling, and MV apparatus geometry. RESULTS: Five studies were identified, with a total of 397 patients. Baseline characteristics were similar between groups, and all patients had moderate to severe secondary MR, with the vast majority in the setting of ischemic cardiomyopathy. A Ring + subvalvular repair consisted of papillary muscle approximation (n=2), papillary muscle relocation (n=2), or secondary chordal cutting (n=1). Follow-up ranged from 10.1 (mean range =0.25-42) to 69 interquartile range (IQR) =23-82 months. When compared with Ring only at last follow-up, a Ring + subvalvular MV repair was associated with: (I) a smaller MR grade (MD =-0.44, 95% CI -0.69 to -0.19; P=0.0005); (II) a reduced risk of moderate or greater recurrent MR (RR =0.43, 95% CI, 0.27-0.66; P=0.0002); (III) a smaller mean LV end-diastolic diameter (MD =-3.56 mm, 95% CI -5.40 to -1.73; P=0.0001) and a greater ejection fraction (MD =2.64%, 95% CI, 0.13-5.15; P=0.04); and, (IV) an improved MV apparatus geometry. There were no differences in operative mortality, post-operative morbidity, or follow-up survival between surgical approaches. CONCLUSIONS: When compared with Ring only, a Ring + subvalvular MV repair is associated with greater LV reverse remodeling and systolic function, less recurrence of moderate or greater MR, and an improved geometry of the MV apparatus at short and mid-term follow-up.
Mihos et al. (Thu,) conducted a meta-analysis in Secondary mitral regurgitation (n=397). Ring annuloplasty with mitral subvalvular intervention vs. Ring annuloplasty only was evaluated on Moderate or greater recurrent mitral regurgitation (RR 0.43, 95% CI 0.27-0.66, p=0.0002). Ring annuloplasty plus subvalvular intervention reduced moderate or greater recurrent mitral regurgitation compared to ring annuloplasty alone (RR 0.43; 95% CI 0.27-0.66; P=0.0002).
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