Victor Dayan1, Gerardo Soca2, Leandro Cura2, Carlos A Mestres3. 1. Centro Cardiovascular, Hospital de Clinicas, Facultad de Medicina, Montevideo, Uruguay. Electronic address: victor_dayan@hotmail.com. 2. Centro Cardiovascular, Hospital de Clinicas, Facultad de Medicina, Montevideo, Uruguay. 3. Department of Cardiovascular Surgery, Hospital Clinico, University of Barcelona, Barcelona, Spain.
Abstract
BACKGROUND: Ischemic mitral regurgitation (IMR) occurs in 20% of patients after myocardial infarction. There is no agreement as to the best surgical option. With no prospective randomized controlled trials available, our objective was to perform a meta-analysis comparing replacement and repair. METHODS: A literature search was performed in PubMed, EMBASE, Ovid, and Google Scholar. The following keywords were included: "ischemic mitral regurgitation" and "repair or replacement." Inclusion and exclusion criteria were used to reflect current surgical practice (subvalvular preservation, ring annuloplasty). Primary outcomes of interest were operative mortality and survival. Secondary outcomes analyzed were change in ejection fraction (EF), left ventricular (LV) dimensions, New York Heart Association (NYHA) class, reoperation rate, and 2+ or greater recurrence of mitral regurgitation. RESULTS: Of 280 articles, only 12 satisfied all inclusion and exclusion criteria. These articles included 2,508 patients, 64% of whom received valve replacement. Operative mortality was lower after repair (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.38-0.85; p = 0.001); no difference was found when only articles with patients operated on mainly after 1998 were included (OR, 0.70; 95% CI, 0.44 -1.12; p = 0.14). Survival was similar (hazard ratio [HR], 0.86; 95% CI, 0.66-1.13; p = 0.28). No differences in EF, ventricular dimensions, NYHA class, and reoperation were found. Regurgitation recurrence was higher in the repair group (OR, 7.51; 95% CI, 3.7-15.23; p < 0.001). CONCLUSIONS: Mitral valve repair is associated with lower operative mortality but higher recurrence of regurgitation in patients with ischemic mitral regurgitation. No differences were found regarding survival, NYHA class, and functional indicators.
BACKGROUND:Ischemic mitral regurgitation (IMR) occurs in 20% of patients after myocardial infarction. There is no agreement as to the best surgical option. With no prospective randomized controlled trials available, our objective was to perform a meta-analysis comparing replacement and repair. METHODS: A literature search was performed in PubMed, EMBASE, Ovid, and Google Scholar. The following keywords were included: "ischemic mitral regurgitation" and "repair or replacement." Inclusion and exclusion criteria were used to reflect current surgical practice (subvalvular preservation, ring annuloplasty). Primary outcomes of interest were operative mortality and survival. Secondary outcomes analyzed were change in ejection fraction (EF), left ventricular (LV) dimensions, New York Heart Association (NYHA) class, reoperation rate, and 2+ or greater recurrence of mitral regurgitation. RESULTS: Of 280 articles, only 12 satisfied all inclusion and exclusion criteria. These articles included 2,508 patients, 64% of whom received valve replacement. Operative mortality was lower after repair (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.38-0.85; p = 0.001); no difference was found when only articles with patients operated on mainly after 1998 were included (OR, 0.70; 95% CI, 0.44 -1.12; p = 0.14). Survival was similar (hazard ratio [HR], 0.86; 95% CI, 0.66-1.13; p = 0.28). No differences in EF, ventricular dimensions, NYHA class, and reoperation were found. Regurgitation recurrence was higher in the repair group (OR, 7.51; 95% CI, 3.7-15.23; p < 0.001). CONCLUSIONS: Mitral valve repair is associated with lower operative mortality but higher recurrence of regurgitation in patients with ischemic mitral regurgitation. No differences were found regarding survival, NYHA class, and functional indicators.
Authors: Bart S. Ferket; Gorav Ailawadi; Annetine C. Gelijns; Michael Acker; Samuel F. Hohmann; Helena L. Chang; Denis Bouchard,; David O. Meltzer; Robert E. Michler; Ellen G. Moquete; Pierre Voisine; John C. Mullen; Anuradha Lala; Michael J. Mack; A. Marc Gillinov; Vinod H. Thourani; Marissa A. Miller; James S. Gammie; Michael K. Parides; Emilia Bagiella; Robert L. Smith; Peter K. Smith; Judy W. Hung; Lopa N. Gupta; Eric A. Rose; Patrick T. O'Gara; Alan J. Moskowitz Journal: Circ Cardiovasc Qual Outcomes Date: 2018-11-14