PMID- 26086215
OWN - NLM
STAT- MEDLINE
DCOM- 20170206
LR  - 20170206
IS  - 1827-191X (Electronic)
IS  - 0021-9509 (Linking)
VI  - 58
IP  - 1
DP  - 2017 Feb
TI  - Additional mitral valve procedure and coronary artery bypass grafting versus 
      isolated coronary artery bypass grafting in the management of significant 
      functional ischemic mitral regurgitation: a meta-analysis.
PG  - 121-130
LID - 10.23736/S0021-9509.16.08852-2 [doi]
AB  - INTRODUCTION: Functional ischemic mitral regurgitation (IMR) is commonly present 
      following acute myocardial infarction (AMI) and tightly associated with a poorer 
      prognosis. The optimal surgical strategy for the management of significant IMR 
      (>/=2+ grade) remains controversial and mitral valve surgery (MVS) at the time of 
      coronary artery bypass grafting (CABG) is still debated. The primary objective of 
      this meta-analysis was to clarify the effects of additional MVS on the prognosis 
      in the patients with significant IMR, compared with isolated CABG. EVIDENCE 
      ACQUISITION: A meta-analysis of eligible studies, reporting concomitant MVS and 
      CABG in comparison with CABG alone in respects to in-hospital mortality, survival 
      and postoperative residual mitral regurgitation (MR) and cardiac functional 
      status, was carried out. The outcomes of interest included in-hospital mortality, 
      one-, three- and five-year survival and postoperative New York Heart Association 
      (NYHA) class, residual MR and left ventricular ejection fraction (LVEF). EVIDENCE 
      SYNTHESIS: Pooling 2 randomized controlled trials (RCTs) (N.=175) and 11 
      observational studies (N.=2661) demonstrated that additional MVS did not 
      significantly influence in-hospital mortality (odds ratio [OR]=1.45, 95% 
      confidence interval [CI] 0.93-2.28, P=0.10) and one- (OR=0.89, 95%CI 0.68-1.15, 
      P=0.37), three- (OR=1.10, 95%CI 0.79-1.55, P=0.56) and five- (OR=0.93, 95%CI 
      0.73-1.18, P=0.55) year survival in comparison with isolated CABG. And pooling 
      neither RCTs nor observational studies alone presented any evidence of 
      significant difference in in-hospital mortality and survival between the two 
      groups. Additionally, concomitant MVS was associated with increased postoperative 
      LVEF (standard mean differences [SMD]=0.28, 95%CI 0.10-0.46, P<0.01) and 
      decreased postoperative residual MR (SMD=-4.22, 95%CI -6.48 to -1.97, P<0.0001). 
      Similar outcomes were obtained when either RCTs or observational studies were 
      pooled alone. Additional MVS appeared to decrease postoperative NYHA functional 
      class (SMD=-0.48, 95%CI -0.97-0.00, P=0.05) with evident heterogeneity (I2=87.5%, 
      P<0.0001). In the subgroup analysis, MVS significantly reduced postoperative NYHA 
      functional class in RCTs (SMD=-1.32, 95%CI -1.67 to -0.97, P<0.0001) whereas it 
      did not among observational studies (SMD=-0.08, 95%CI -0.27-0.11, P=0.42), and 
      heterogeneity was completely eliminated (for RCTs, I2=0%, P=0.49; for 
      observational studies, I2=0%, P=0.40). CONCLUSIONS: Concomitant MVS at the time 
      of CABG is associated with greater improvement in postoperative residual MR and 
      LVEF in the patients with significant IMR. However, the evidence is still lacking 
      of advantages of combined surgery over CABG alone regarding in-hospital 
      mortality, survival and postoperative NYHA function class. Additional RCTs are 
      needed to assess the safety and efficacy outcomes of adding mitral valve 
      procedure in the surgical intervention of significant IMR.
FAU - Teng, Zhitao
AU  - Teng Z
AD  - Cardiovascular Center, Weihai Municipal Hospital, Weihai, China.
FAU - Ma, Xiaochun
AU  - Ma X
AD  - Department of Cardiac Surgery, Shandong Provincial Hospital affiliated to 
      Shandong University, Jinan, China.
AD  - Shandong University School of Medicine, Jinan, China.
FAU - Zhang, Qian
AU  - Zhang Q
AD  - Department of Cardiac Surgery, Shandong Provincial Hospital affiliated to 
      Shandong University, Jinan, China.
FAU - Yun, Yan
AU  - Yun Y
AD  - Shandong University School of Medicine, Jinan, China.
FAU - Ma, Chi
AU  - Ma C
AD  - Shandong University School of Medicine, Jinan, China.
FAU - Hu, Songtao
AU  - Hu S
AD  - Department of Postgraduate, Taishan Medical University, Taian, China.
FAU - Zou, Chengwei
AU  - Zou C
AD  - Department of Cardiac Surgery, Shandong Provincial Hospital affiliated to 
      Shandong University, Jinan, China - zouchengwei@sdu.edu.cn.
AD  - Shandong University School of Medicine, Jinan, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20150618
PL  - Italy
TA  - J Cardiovasc Surg (Torino)
JT  - The Journal of cardiovascular surgery
JID - 0066127
SB  - IM
MH  - *Coronary Artery Bypass/adverse effects/mortality
MH  - Hospital Mortality
MH  - Humans
MH  - Mitral Valve/diagnostic imaging/*surgery
MH  - Mitral Valve Insufficiency/diagnosis/etiology/mortality/*surgery
MH  - Myocardial Infarction/complications/diagnosis/mortality/*surgery
MH  - Odds Ratio
MH  - Postoperative Complications/etiology/mortality
MH  - Risk Assessment
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Stroke Volume
MH  - Time Factors
MH  - Treatment Outcome
MH  - Ventricular Function, Left
EDAT- 2015/06/19 06:00
MHDA- 2017/02/07 06:00
CRDT- 2015/06/19 06:00
PHST- 2015/06/19 06:00 [pubmed]
PHST- 2017/02/07 06:00 [medline]
PHST- 2015/06/19 06:00 [entrez]
AID - R37Y9999N00A150054 [pii]
AID - 10.23736/S0021-9509.16.08852-2 [doi]
PST - ppublish
SO  - J Cardiovasc Surg (Torino). 2017 Feb;58(1):121-130. doi: 
      10.23736/S0021-9509.16.08852-2. Epub 2015 Jun 18.