1 The First Clinical Medical College, Lanzhou University, 730000 Lanzhou, Gansu, China
2 Department of Cardiovascular Surgery, First Hospital of Lanzhou University, 730000 Lanzhou, Gansu, China
†These authors contributed equally.
Abstract
This study aims to systematically review the efficacy of various surgical approaches in the treatment of ischemic mitral regurgitation (IMR).
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.
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.
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.
INPLASY202420049. This study can be accessed at the following detailed address: https://inplasy.com/inplasy-2024-2-0049/, last accessed on February 11, 2024.
Keywords
- coronary artery bypass grafting
- mitral valve repair
- mitral valve replacement
- ischemic mitral regurgitation
- systematic review/network meta-analysis
Ischemic mitral regurgitation (IMR) is a prevalent complication in post-myocardial infarction patients, with an estimated prevalence of approximately 40%–50%, and nearly 10% of these patients experiencing moderate to severe IMR [1, 2]. This condition is associated with an increased risk of mortality and heart failure, with the one-year mortality rate estimated at 10% for mild IMR, rising to 40% for severe IMR. Moreover, patients with myocardial infarction and concurrent IMR face a threefold increased risk of developing heart failure [3]. The primary mechanisms for IMR following myocardial infarction are identified as follows: (1) Partial obstruction or blockage of the coronary artery resulting in myocardial ischemic necrosis, subsequent rupture of papillary muscles and chordae tendineae, and consequent valve prolapse and IMR; (2) Ventricular remodeling induced by coronary heart disease, characterized by ventricular dilation resulting in passive enlargement of the mitral annulus and relative insufficiency of mitral closure. Displacement of papillary muscles and reduced annulus closure strength also contribute to IMR [4, 5]. IMR is characterized by localized wall motion abnormalities, often secondary to coronary artery disease, with the mitral leaflets and chordae tendineae typically less structurally affected [6, 7].
Currently, IMR is primarily managed through a variety of treatment modalities including medications, cardiac resynchronization therapy, coronary artery bypass grafting (CABG), mitral valve repair (MVr), mitral valve replacement (MVR), interventional treatments, or a combination of these surgical approaches. Some perspectives suggest that CABG effectively restores myocardial blood flow, ameliorates ventricular remodeling, and reduces wall motion abnormalities [8, 9]. However, reports suggest that CABG alone in patients with moderate to severe IMR may result in a mortality or heart failure rate up to 50% [10, 11]. Moreover, the efficacy of CABG alone may be temporary, with recurrence of mitral regurgitation and other complications frequently observed postoperatively [12]. Persistent mitral regurgitation increases ventricular load, potentially leading to eventual heart failure [13]. While MVR or MVr alone can effectively address mitral regurgitation, they do not address ischemic myocardium. Post-MVR, long-term anticoagulation is required, with an annual incidence of bleeding or thromboembolism ranging from 2% to 7%, along with risks of paravalvular leak and endocarditis [9]. Combining CABG with MVr or MVR considerably extends surgery duration, extracorporeal circulation, intubation, and anesthesia times, thereby increasing the risk of complications [14]. Pharmacotherapy and cardiac resynchronization therapy are primarily utilized for mild IMR. The surgical treatment of IMR remains a subject of debate, prompting this study to employ network Meta-analysis to evaluate the efficacy of various surgical interventions for IMR, with the aim of offering guidance for clinical decision-making.
A systematic review of selected publications has been conducted following the preferred reporting items for Systematic Reviews and Meta-analysis guidelines, and the full research protocol has been registered in the INPLASY database (INPLASY202420049).
A comprehensive search was performed in PubMed, Embase, Cochrane Library and Web of Science databases, covering the period from their establishment to February 2024. In addition, manual searches of relevant conference proceedings were conducted to enhance the literature review. The search strategy employed a combination of Medical Subject Headings (MeSH) terms and free-text keywords, focusing on terms such as ischemic mitral valve incompetence, ischemic mitral valve insufficiency, ischemic mitral valve regurgitation, ischemic bicuspid heart valve incompetence, mitral valve replacement, coronary artery bypass graft, edge-to-edge transcatheter mitral valve repair, and mitral valve transcatheter edge-to-edge repair.
The inclusion criteria for studies were as follows: (1) Randomized controlled trials (RCTs). (2) Patients diagnosed with moderate-to-severe IMR using cardiac color Doppler ultrasound [15]. (3) Interventional methods comprising CABG, MVR, MVr, transcatheter mitral valve edge-to-edge repair (TEER) with the MitraClip device (Abbott, Santa Clara, CA, USA), CABG+MVR, and CABG+MVr. (4) Study outcomes covering 30-day all-cause mortality; major bleeding events; stroke; renal complications; neurological complications; respiratory complications. Exclusion criteria included: (1) Repeatedly published studies. (2) Literature with inaccessible full texts or incomplete data. (3) Reviews, conference abstracts, or correspondence. (4) Non-clinical research such as animal studies.
The literature selection and data extraction were conducted independently by two researchers, with a process for cross-verification in place. Disagreements were resolved through mutual discussion or consultation with a third party. The extracted data included: (1) Baseline data of the studies: first author, publication year, country, study type, intervention actions, and sample size. (2) Characteristics of patients: sex, age, body mass index (BMI), hypertension, hyperlipidemia, diabetes, history of myocardial infarction, etc. (3) Data required for bias risk evaluation. (4) Data on outcome measures: 30-day all-cause mortality; major bleeding events; stroke; renal complications; neurological complications and respiratory complications.
The quality assessment of the included RCT studies was independently conducted by two researchers using RevMan 5.3 software (Cochrane Collaboration, London, UK), a tool recommended by the Cochrane Collaboration for systematic reviews. This tool evaluates the risk of bias across six aspects: method of randomization, allocation concealment, blinding, completeness of outcome data, publication bias, and other biases. The findings were then cross-checked to ensure consistency and accuracy in the assessment of bias risk.
Network meta-analysis in this study was conducted using Stata 17.0 software
(Stata Corp LLC, College Station, TX, USA). The effect size for count data was
determined using the odds ratio (OR), and for measurement data,
the mean difference (MD) was used. Both effect sizes were accompanied by their
respective 95% confidence intervals (CI). Heterogeneity among the results of the
included studies was assessed using the Chi-squared test (
The initial search identified 2460 publications, of which 810 duplicates were subsequently removed. Screening of titles and abstracts led to the exclusion of 1614 publications. After a full-text review, an additional 16 publications were excluded, leaving 20 studies [16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35] for inclusion. The process of literature selection is illustrated in Fig. 1.
Fig. 1.
Flow chart of the publication selection process, based on the PRISMA statement. PRISMA, Preferred Reporting Items for Systematic reviews and Meta-Analyses; RCT, randomized controlled trial.
The studies included were published between 2001 and 2022, involving a total of 3111 patients. Notably, Qiu et al. [30] had a sample size of 378, which is the largest among all the included studies. The interventions assessed in this study included CABG, MVR, MVr, TEER using MitraClip, CABG+MVR, and CABG+MVr. The average age of patients across the study was 65.6 years, with a range of 54.3 to 72.3 years. The proportion of male patients was 64.0% with a range of 33.1% to 100.0%. The prevalence of comorbidities among the patient population was as follows: hypertension was present in 55.0% of patients (range 10.8% to 93.8%), hyperlipidemia in 47.9% (range 24.0% to 77.1%), diabetes in 38.0% (range 15.6% to 66.7%), myocardial infarction in 61.8% (range 35.6% to 83.0%), COPD in 15.0% (range 0% to 50%), and atrial fibrillation in 15.9% (range 0% to 50%). Further details regarding the fundamental characteristics of these studies are provided in Table 1 (Ref. [16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35]).
| Study | General characteristics | Past complications (%) | Preoperative examination | Intervention | ||||||||||
| Country | Type of study | Total (n) | Male (%) | Age | HTN | HPL | DM | MI | COPD | AF | MR area (cm2) | LVEF (%) | T/C | |
| Sá, MPBO et al. 2013 [31] | Brazil | RCT | 42 | 54/54 | NR | 94/85 | NR | 25/42 | 50/46 | 13/0 | NR | NR | NR | CABG+MVR/CABG |
| Dufendach, K et al. 2020 [18] | US | RCT | 358 | 51/33 | 69/70 | 87/87 | 77/78 | 47/49 | 54/58 | 41/27 | NR | NR | 49/43 | CABG+MVR/CABG+MVr |
| Lee, M et al. 2018 [26] | China | RCT | 22 | 75/100 | 63/61 | 75/44 | 50/28 | 25/67 | NR | 50/6 | 50/33 | NR | 46/30 | CABG+MVR/CABG+MVr |
| Chan et al. 2012 [17] | US | RCT | 73 | 33/74 | 70/71 | 59/50 | NR | 38/35 | 72/74 | 3/6 | 10/6 | 0.18/0.21 | NR | CABG/CABG+MVr |
| Fattouch et al. 2022 [19] | Italy | RCT | 102 | 65/63 | 66/64 | 43/54 | NR | 59/58 | 82/83 | 9/8 | NR | NR | 43/42 | CABG/CABG+MVr |
| Goland et al. 2009 [21] | US | RCT | 83 | NR | 68/69 | 61/65 | NR | 29/36 | 61/44 | 14/15 | NR | NR | 37/39 | CABG+MVr/CABG |
| Jeong et al. 2012 [23] | Korea | RCT | 140 | 58/73 | 65/64 | 69/54 | NR | 46/49 | NR | NR | 4/18 | NR | NR | CABG/CABG+MVr |
| Ji et al. 2019 [24] | China | RCT | 200 | 83/78 | 74/74 | 67/63 | 24/28 | 37/41 | 45/36 | 12/14 | NR | 0.17/0.15 | 43/47 | CABG+MVr/CABG |
| Khallaf et al. 2020 [25] | Egypt | RCT | 60 | 55/60 | 55/54 | 60/45 | NR | 60/55 | 65/60 | NR | NR | NR | 48/50 | CABG+MVr/CABG |
| Tribak et al. 2018 [34] | France | RCT | 55 | 86/81 | 58/57 | 71/34 | 42/34 | NR | 64/50 | NR | 14/0 | NR | NR | CABG+MVr/CABG |
| Wang et al. 2022 [35] | China | RCT | 162 | 49/48 | 72/72 | 11/10 | NR | 47/45 | 74/69 | 31/24 | NR | NR | NR | CABG+MVr/MitraClip |
| Acker et al. 2014 [16] | US | RCT | 251 | 61/62 | 69/68 | NR | NR | 38/33 | 79/70 | NR | 36/28 | 0.40/0.39 | 42/40 | MVr/MVR |
| Gimpel et al. 2020 [20] | AU | RCT | 119 | 72/67 | 71/72 | 61/72 | 66/72 | 30/33 | NR | NR | NR | NR | NR | MVr/MVR |
| Grossi et al. 2001 [22] | US | RCT | 223 | 64/59 | NR | NR | NR | 30/31 | NR | NR | NR | NR | NR | MVr/MVR |
| Li et al. 2018 [27] | China | RCT | 218 | 75/78 | 62/61 | 59/55 | 46/46 | 16/20 | NR | 6/6 | 7/5 | NR | NR | MVr/MVR |
| Li et al. 2019 [28] | China | RCT | 154 | 83/79 | 62/62 | 58/52 | 38/42 | 25/20 | NR | 8/4 | 17/8 | NR | 54/55 | MVr/MVR |
| Qiu et al. 2017 [30] | China | RCT | 378 | 69/63 | 66/66 | NR | NR | NR | NR | NR | 9/9 | NR | 50/58 | MVr/MVR |
| Silberman et al. 2006 [32] | US | RCT | 80 | 74/93/79 | 62/67/68 | 50/57/61 | NR | 45/57/46 | NR | 13/14/21 | NR | NR | NR | MVr/MVR/CABG |
| Michler et al. 2016 [29] | US | RCT | 301 | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR | CABG/CABG+MVr |
| Toktas et al. 2016 [33] | Turkey | RCT | 90 | 48/41 | 61/63 | NR | NR | 59/59 | NR | 14/17 | 16/17 | NR | NR | CABG+MVr/CABG |
| Total | NR | NR | 3111 | 64/67 | 66/57 | 62/55 | 49/47 | 39/43 | 65/59 | 18/12 | 18/14 | 0.25/0.25 | 46/49 | NR |
NR, not reported; HTN, hypertension; HPL, hyperlipidemia; DM, diabetes mellitus; MI, myocardial infarction; COPD, chronic obstructive pulmonary disease; AF, atrial fibrillation; MR, mitral regurgitation; LVEF, left ventricular ejection fraction; RCT, randomized controlled trial; T/C, test group/control group; CABG, coronary artery bypass grafting; MVr, mitral valve repair; MVR, mitral valve replacement.
The risk of bias in the included studies is shown in Fig. 2a,b.
Fig. 2.
Included study bias risk assessment results. (a) Risk of bias bar chart; (b) Risk of bias summary chart.
The overall consistency test revealed good alignment between direct and indirect
comparisons (p
| Intervention | Direct Coef | Std. Err | Indirect Coef | Std. Err | Difference Coef | Std. Err | p |
| CABG-CABG+MVR | –0.22 | 1.27 | 0.25 | 0.45 | –0.47 | 1.35 | 0.73 |
| CABG-CABG+MVr | –0.52 | 0.26 | –1.00 | 1.32 | 0.47 | 1.35 | 0.73 |
| CABG-MVR | –0.69 | 0.88 | –0.30 | 1.63 | –0.40 | 2.05 | 0.85 |
| CABG-MVr | –1.35 | 0.74 | –1.76 | 1.82 | 0.40 | 2.05 | 0.85 |
| CABG+MVR-CABG+MVr | –0.77 | 0.36 | –0.31 | 1.30 | –0.47 | 1.35 | 0.73 |
| CABG+MVr-MitraClip | 1.22 | 0.68 | 1.65 | 2.97 | –0.43 | 2.97 | 1.00 |
CABG, coronary artery bypass grafting; MVR, mitral valve replacement; MVr, mitral valve repair; Coef, coefficient; Std. Err, standard error.
Focusing on the 30-day all-cause mortality rate, the network diagram is illustrated in Fig. 3. This diagram displays several interventions forming closed network relationships. The most substantial comparison, involving seven experiments, was between CABG and CABG+MVr. Comparisons among other interventions were less frequent in original studies, with CABG+MVr involving the largest participant group (947 participants).
Fig. 3.
Network diagram of 30-day all-cause mortality rate. CABG, coronary artery bypass grafting; MVR, mitral valve replacement; MVr, mitral valve repair.
Details of the probability ranking of all outcome measures are provided in Table 3, and the Grade tool was used to evaluate the conclusions obtained from this network meta-analysis, as detailed in Table 4.
| Intervention | 30-day all-cause mortality | Major bleeding events | Stroke | Renal complications | Neurological complications | Respiratory complications | ||||||
| SUCRA | Rank | SUCRA | Rank | SUCRA | Rank | SUCRA | Rank | SUCRA | Rank | SUCRA | Rank | |
| CABG+MVr | 70.8 | 2 | 44.9 | 3 | 49.8 | 3 | 88.2 | 1 | 26.5 | 4 | 28.3 | 3 |
| CABG+MVR | 26.0 | 5 | 39.4 | 4 | 56.0 | 2 | 30.0 | 5 | 62.8 | 2 | 88.4 | 1 |
| MVr | 96.7 | 1 | NR | NR | 29.5 | 4 | 47.9 | 3 | NR | NR | NR | NR |
| MVR | 60.6 | 3 | NR | NR | 23.3 | 5 | 15.5 | 6 | NR | NR | NR | NR |
| CABG | 33.4 | 4 | 48.3 | 2 | 91.3 | 1 | 76.5 | 2 | 70.7 | 1 | 55.4 | 2 |
| MitraClip | 12.5 | 6 | 67.4 | 1 | NR | NR | 41.9 | 4 | 40.0 | 3 | 27.9 | 4 |
CABG, coronary artery bypass grafting; MVR, mitral valve replacement; MVr, mitral valve repair; SUCRA, the surface under the cumulative ranking curve; NR, not reported.
| Certainty assessment | № of patients | Certainty | ||||||
| № of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Publication bias | ||
| 30-day all-cause mortality | ||||||||
| 20 | RCT | serious | Not serious | Not serious | Not serious | Undetected | 3111 | Moderate |
| Major bleeding events | ||||||||
| 7 | RCT | Very serious | Not serious | Not serious | Not serious | Undetected | 1226 | Low |
| Stroke | ||||||||
| 8 | RCT | Not serious | Not serious | Not serious | serious | Undetected | 1635 | Moderate |
| Renal complications | ||||||||
| 14 | RCT | Not serious | Not serious | Not serious | Not serious | Undetected | 2388 | High |
| Neurological complications | ||||||||
| 5 | RCT | Not serious | Not serious | Not serious | Not serious | Undetected | 735 | High |
| Respiratory complications | ||||||||
| 4 | RCT | Not serious | Not serious | Not serious | serious | Undetected | 645 | Moderate |
RCT, randomized controlled trial.
The analysis incorporated data from 20 RCTs [16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35] focusing on the 30-day
all-cause mortality rate. The findings revealed that MVr significantly reduced
the 30-day all-cause mortality rate compared to TEER using MitraClip [OR= 8.17, 95% CI (1.20, 55.67)], MVR [OR = 0.43, 95% CI (0.23,
0.79)], CABG+MVR [OR = 0.20, 95% CI (0.04, 0.91)], and CABG
[OR = 0.24, 95% CI (0.07, 0.87)]. Furthermore, the 30-day
mortality rate for CABG+MVr was significantly lower than for CABG+MVR [OR = 0.48, 95% CI (0.24, 0.94)] and CABG [OR = 0.58, 95% CI (0.35, 0.96)], all with statistical significance (p
Fig. 4.
The probability ranking of all outcomes. (a) 30-day all-cause mortality rate. (b) Major bleeding events. (c) Stroke. (d) Renal complications. (e) Neurological complications. (f) Respiratory complications. CABG, coronary artery bypass grafting; MVR, mitral valve replacement; MVr, mitral valve repair.
| 30-day all-cause mortality | |||||
|---|---|---|---|---|---|
| MitraClip | |||||
| 8.17 (1.20, 55.67) | MVr | ||||
| 3.51 (0.50, 24.49) | 0.43 (0.23, 0.79) | MVR | |||
| 3.39 (0.89, 12.88) | 0.41 (0.10, 1.64) | 0.96 (0.24, 3.94) | CABG+MVr | ||
| 1.62 (0.36, 7.24) | 0.20 (0.04, 0.91) | 0.46 (0.10, 2.17) | 0.48 (0.24, 0.94) | CABG+MVR | |
| 1.96 (0.47, 8.18) | 0.24 (0.07, 0.87) | 0.56 (0.15, 2.08) | 0.58 (0.35, 0.96) | 1.21 (0.53, 2.77) | CABG |
| Major bleeding events | |||||
| MitraClip | |||||
| 0.49 (0.03, 9.68) | CABG+MVr | ||||
| 0.43 (0.01, 14.68) | 0.88 (0.13, 5.77) | CABG+MVR | |||
| Stroke | |||||
| MVr | |||||
| 0.89 (0.36, 2.23) | MVR | ||||
| 3.02 (0.13, 68.84) | 3.38 (0.14, 80.38) | CABG+MVr | |||
| 3.36 (0.11, 99.18) | 3.76 (0.12, 115.45) | 1.11 (0.30, 4.08) | CABG+MVR | ||
| 8.28 (0.44, 154.17) | 9.28 (0.48, 180.52 | 2.74 (0.91, 8.30) | 2.47 (0.45, 13.62) | CABG | |
| Renal complications | |||||
| MitraClip | |||||
| 0.97 (0.19, 4.86) | MVr | ||||
| 0.59 (0.11, 3.09) | 0.61 (0.34, 1.09) | MVR | |||
| 1.96 (0.87, 4.41) | 2.03 (0.50, 8.20) | 3.33 (0.78, 9.16) | CABG+MVr | ||
| 0.83 (0.29, 2.38) | 0.85 (0.18, 3.98) | 1.40 (0.29, 6.85) | 0.42 (0.21, 0.83) | CABG+MVR | |
| 1.68 (0.60, 4.70) | 1.73 (0.50, 6.01) | 2.85 (0.78, 9.44) | 0.85 (0.45, 1.62) | 2.03 (0.82, 5.03) | CABG |
| Neurological complications | |||||
| MitraClip | |||||
| 0.43 (0.01, 13.28) | CABG+MVr | ||||
| 0.38 (0.09, 1.57) | 0.89 (0.04, 9.40) | CABG+MVR | |||
| 0.91 (0.12, 6.85) | 2.13 (0.04, 9.58) | 2.39 (0.20, 9.30) | CABG | ||
| Respiratory complications | |||||
| MitraClip | |||||
| 0.68 (0.17, 2.65) | CABG+MVr | ||||
| 0.74 (0.37, 1.49) | 1.09 (0.34, 3.52) | CABG+MVR | |||
| 2.29 (0.52, 10.21) | 3.38 (0.45, 9.54) | 3.10 (0.60, 9.19) | CABG | ||
CABG, coronary artery bypass grafting; MVR, mitral valve replacement; MVr, mitral valve repair.
7 RCTs [17, 18, 24, 29, 31, 33, 35] were included in the evaluation of major
bleeding events. The network meta-analysis indicated no significant statistical
differences among the various interventions (p
8 RCTs [16, 17, 18, 24, 27, 28, 29, 32] were included in the analysis of stroke incidence.
The results indicated no significant differences among the interventions
(p
14 RCTs [16, 17, 18, 20, 23, 26, 27, 28, 29, 30, 31, 32, 33, 35] were included in the assessment of renal
complications. The network meta-analysis indicated that CABG combined with MVr
significantly reduced the incidence of renal complications compared to CABG
combined with MVR [OR = 0.42, 95% CI (0.21, 0.83)],
with statistical significance (p
Neurological complications were assessed in 5 RCTs [23, 29, 32, 34, 35]. The
network meta-analysis revealed no significant differences among the various
interventions (p
Respiratory complications were examined in 4 RCTs [23, 29, 31, 35]. The network
meta-analysis did not identify significant differences among the interventions
(p
As the global population ages, there has been a notable increase in the incidence of Coronary Artery Disease (CAD), a trend attributed to medical advancements that have improved the survival rates of CAD patients. Consequently, there has been a corresponding rise in cases of IMR following CAD surgery [3, 36]. IMR develops as a consequence of myocardial injury induced by CAD, leading to adverse ventricular remodeling. The primary pathological processes of IMR include left ventricle and mitral annulus enlargement, dysfunction, and lateral displacement of the papillary muscles, as well as reduced valvular coaptation. These pathological processes dynamically change with variations in cardiac preload, rhythm, and other factors [37]. Given that the pathology of IMR primarily affects the myocardium rather than the valve itself, its treatment significantly differs from that of degenerative MR. The limitation of solely performing CABG is the potential for residual and recurrent MR. Conversely, procedures like mitral valve repair or replacement, as well as other related surgical procedures, have drawbacks such as longer cardiopulmonary bypass times and inadequate revascularization of the ischemic myocardium. Interventional treatment for IMR is still in its exploratory stages, thus determining the specific efficacies of various surgical treatments for IMR is a pressing concern.
A 2009 study by Fattouch et al. [38] found no statistical difference in
the 30-day all-cause mortality rate between IMR patients undergoing only CABG and
those undergoing CABG combined with MVr (OR = 1.58, p = 0.29).
In 2020, research by Dufendach et al. [18] showed that the 30-day
all-cause mortality rate for IMR patients undergoing CABG combined with MVR was
notably higher than for CABG combined with MVr (OR = 1.95, p =
0.04), and the incidence of renal complications was also higher in the CABG
combined with MVR group (OR = 2.38, p
This research encompasses certain limitations: (1) The type of valve used in patients undergoing MVR, MVr, or associated surgeries differs, which might have an impact on the outcomes; (2) The preoperative cardiac functions of patients are varied, leading to potential disparities in post-surgery mortality and the occurrence of various complications; (3) The majority of included studies have relatively small sample sizes, raising the possibility of Type II errors; (4) The study lacks a detailed description and differentiation of the grades of MR; (5) This study only included RCTs and excluded retrospective studies, which may introduce bias into the research findings.
In conclusion, based on the findings of this study, MVr or CABG+MVr seems to be the most effective approach in reducing short-term mortality for IMR patients. When compared to CABG+MVR, CABG+MVr leads to less damage to renal function. Additionally, no notable differences were observed in major bleeding events and other complications among the different surgical treatments for IMR. However, it is important to note that these conclusions require further validation through more stringent clinical trials.
The original data has been uploaded as an attachment to the manuscript.
ZW and BS is responsible for topic selection and research design; SD and YC are responsible for paper screening and data collection; XL and SL are responsible for the data analysis; ZW, YC and XL are responsible for paper writing; BS, SD and SL are responsible for paper review and revision. All authors agree to the submitted version of the manuscript and to the author’s own contributions, and to ensure questions relating to the accuracy or completeness of any part of the work. All authors read and approved the final manuscript. All authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work.
Not applicable.
Not applicable.
This study was supported by the Natural Science Foundation of Gansu Province (22JR11RA037) and First Hospital of Lanzhou University hospital funding (ldyyyn2022-40).
The authors declare no conflict of interest.
Supplementary material associated with this article can be found, in the online version, at https://doi.org/10.31083/j.rcm2511425.
References
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