PMID- 26888462
OWN - NLM
STAT- MEDLINE
DCOM- 20170719
LR  - 20220318
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 50
IP  - 2
DP  - 2016 Aug
TI  - Meta-analysis of concomitant mitral valve repair and coronary artery bypass 
      surgery versus isolated coronary artery bypass surgery in patients with moderate 
      ischaemic mitral regurgitation.
PG  - 212-22
LID - 10.1093/ejcts/ezw022 [doi]
AB  - Ischaemic mitral regurgitation (IMR) is a complication of coronary artery disease 
      with normal chordal and leaflet morphology. Controversy surrounds the issue of 
      appropriate surgical management of moderate IMR. With the present meta-analysis, 
      we aimed to determine whether the addition of mitral valve (MV) repair to 
      coronary artery bypass grafting (CABG) improved clinical outcome over CABG alone 
      in patients with moderate IMR. Databases were searched for studies reporting on 
      clinical outcomes after CABG and MV repair or CABG alone for moderate IMR. 
      Clinical end-points were operative mortality, survival, New York Heart 
      Association (NYHA) class >/=2 and MR grade >/=2 at last follow-up. A total of five 
      observational and four randomized controlled trials (RCTs) were identified. The 
      mean follow-up was 2.7 years. An analysis of all studies revealed increased 
      operative risk in the concomitant CABG and MV repair group risk ratio [RR] 2.02 
      [95% confidence interval (CI) 1.15, 3.56], P = 0.01, I(2) = 0%. However, an 
      analysis of RCTs only showed that the operative risk was equivalent [RR 1.05 (95% 
      CI 0.34, 3.30), P = 0.93, I(2) = 0%]. Pooled hazard ratio (HR) on survival did 
      not favour either procedure [all studies: HR 1.08 (95% CI 0.77, 1.50), P = 0.66, 
      I(2) = 0%; RCTs only: HR 0.89 (95% CI 0.47, 1.70), P = 0.73, I(2) = 0%]. The 
      incidence of exercise intolerance quantified as NYHA class >/=2 was similar between 
      groups (all studies: RR 0.72 (95% CI 0.42, 1.24), P = 0.24, I(2) = 77%; RCTs 
      only: RR 0.61 (95% CI 0.24, 1.55), P = 0.30, I(2) = 83%]. Risk of residual MR 
      grade >/=2 was higher in the CABG only group [all studies: RR 0.30 (95% CI 0.16, 
      0.60), P < 0.001, I(2) = 83%; RCTs only: RR 0.20 (95% CI 0.04, 0.90), P = 0.04, 
      I(2) = 72%]. There is neither increased operative mortality nor survival benefit 
      associated with concomitant CABG and MV repair for IMR of moderate degree over 
      CABG alone. Further studies with long-term follow-up data and sub-group analyses 
      of current data are needed to define a subset of patients whose survival and 
      functional status may improve with the concomitant MV repair.
CI  - (c) The Author 2016. Published by Oxford University Press on behalf of the European 
      Association for Cardio-Thoracic Surgery. All rights reserved.
FAU - Kopjar, Tomislav
AU  - Kopjar T
AD  - University of Zagreb School of Medicine, Department of Cardiac Surgery, 
      University Hospital Centre Zagreb, Zagreb, Croatia tkopjar@gmail.com.
FAU - Gasparovic, Hrvoje
AU  - Gasparovic H
AD  - University of Zagreb School of Medicine, Department of Cardiac Surgery, 
      University Hospital Centre Zagreb, Zagreb, Croatia.
FAU - Mestres, Carlos A
AU  - Mestres CA
AD  - Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab 
      Emirates.
FAU - Milicic, Davor
AU  - Milicic D
AD  - University of Zagreb School of Medicine, Department of Cardiovascular Diseases, 
      University Hospital Centre Zagreb, Zagreb, Croatia.
FAU - Biocina, Bojan
AU  - Biocina B
AD  - University of Zagreb School of Medicine, Department of Cardiac Surgery, 
      University Hospital Centre Zagreb, Zagreb, Croatia.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20160216
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Coronary Artery Bypass/*methods
MH  - Coronary Artery Disease/complications/*surgery
MH  - Heart Valve Prosthesis Implantation/*methods
MH  - Humans
MH  - Mitral Valve/*surgery
MH  - Mitral Valve Insufficiency/*surgery
MH  - Myocardial Ischemia/complications/*surgery
OTO - NOTNLM
OT  - Coronary bypass
OT  - Ischaemic mitral regurgitation
OT  - Meta-analysis
OT  - Mitral valve repair
OT  - Outcomes
EDAT- 2016/02/19 06:00
MHDA- 2017/07/20 06:00
CRDT- 2016/02/19 06:00
PHST- 2015/09/08 00:00 [received]
PHST- 2016/01/11 00:00 [accepted]
PHST- 2016/02/19 06:00 [entrez]
PHST- 2016/02/19 06:00 [pubmed]
PHST- 2017/07/20 06:00 [medline]
AID - ezw022 [pii]
AID - 10.1093/ejcts/ezw022 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2016 Aug;50(2):212-22. doi: 10.1093/ejcts/ezw022. Epub 
      2016 Feb 16.