Treatment options for ischemic mitral regurgitation: A meta-analysis.
Aged
Aged, 80 and over
Cardiovascular Agents
/ adverse effects
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
/ adverse effects
Hospital Mortality
Humans
Male
Middle Aged
Mitral Valve
/ physiopathology
Mitral Valve Annuloplasty
/ adverse effects
Mitral Valve Insufficiency
/ etiology
Myocardial Ischemia
/ complications
Patient Readmission
Postoperative Complications
/ mortality
Prosthesis Design
Recovery of Function
Reoperation
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
ischemic mitral regurgitation
mitral valve
mitral valve repair
mitral valve replacement
Journal
The Journal of thoracic and cardiovascular surgery
ISSN: 1097-685X
Titre abrégé: J Thorac Cardiovasc Surg
Pays: United States
ID NLM: 0376343
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
received:
08
10
2019
revised:
12
05
2020
accepted:
15
05
2020
pubmed:
28
7
2020
medline:
1
2
2022
entrez:
28
7
2020
Statut:
ppublish
Résumé
Treatment of ischemic mitral regurgitation (IMR) is in evolution, as percutaneous procedures and complex surgical repair have been recently investigated in randomized clinical trials and matched studies. This study aims to review and compare the current treatment options for IMR. A comprehensive literature search was conducted using electronic databases. The primary outcome was all-cause long-term mortality. The secondary outcomes were perioperative mortality, unplanned rehospitalization, reoperation, and composite end points as defined in the original articles. A total of 12 articles met the inclusion criteria and were included in the final meta-analysis. The MitraClip procedure did not confer a significant benefit in mortality and repeated hospitalization compared with medical therapy alone. In patients with moderate IMR, the adjunct of mitral procedure over coronary artery bypass graft is not associated with clinical improvements. When evaluating mitral valve (MV) replacement versus repair, hospital mortality was greater among patients undergoing replacement (odds ratio [OR], 1.91; P = .009), but both reoperation and readmission rates were lower (OR, 0.60, P = .05; and OR, 0.45, P < .02, respectively). Comparing restrictive annuloplasty alone with adjunctive subvalvular repair, subvalvular procedures resulted in fewer readmissions (OR, 0.50; P = .06) and adverse composite end points (P = .009). MitraClip procedure is not associated with improved outcomes compared with medical therapy. MV replacement is associated with increased early mortality but reduced reoperation rate and readmission rate compared with MV repair using annuloplasty in moderate-to-severe IMR. Despite no significant benefit in isolated outcomes comparing annular and adjunct subvalvular procedures, the adjunct of subvalvular procedures reduces the risk of major postoperative adverse events.
Sections du résumé
BACKGROUND
BACKGROUND
Treatment of ischemic mitral regurgitation (IMR) is in evolution, as percutaneous procedures and complex surgical repair have been recently investigated in randomized clinical trials and matched studies. This study aims to review and compare the current treatment options for IMR.
METHODS
METHODS
A comprehensive literature search was conducted using electronic databases. The primary outcome was all-cause long-term mortality. The secondary outcomes were perioperative mortality, unplanned rehospitalization, reoperation, and composite end points as defined in the original articles.
RESULTS
RESULTS
A total of 12 articles met the inclusion criteria and were included in the final meta-analysis. The MitraClip procedure did not confer a significant benefit in mortality and repeated hospitalization compared with medical therapy alone. In patients with moderate IMR, the adjunct of mitral procedure over coronary artery bypass graft is not associated with clinical improvements. When evaluating mitral valve (MV) replacement versus repair, hospital mortality was greater among patients undergoing replacement (odds ratio [OR], 1.91; P = .009), but both reoperation and readmission rates were lower (OR, 0.60, P = .05; and OR, 0.45, P < .02, respectively). Comparing restrictive annuloplasty alone with adjunctive subvalvular repair, subvalvular procedures resulted in fewer readmissions (OR, 0.50; P = .06) and adverse composite end points (P = .009).
CONCLUSIONS
CONCLUSIONS
MitraClip procedure is not associated with improved outcomes compared with medical therapy. MV replacement is associated with increased early mortality but reduced reoperation rate and readmission rate compared with MV repair using annuloplasty in moderate-to-severe IMR. Despite no significant benefit in isolated outcomes comparing annular and adjunct subvalvular procedures, the adjunct of subvalvular procedures reduces the risk of major postoperative adverse events.
Identifiants
pubmed: 32713629
pii: S0022-5223(20)31262-9
doi: 10.1016/j.jtcvs.2020.05.041
pii:
doi:
Substances chimiques
Cardiovascular Agents
0
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
607-622.e14Commentaires et corrections
Type : CommentIn
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Informations de copyright
Copyright © 2020 The American Association for Thoracic Surgery. All rights reserved.