When to repair ischemic mitral valve regurgitation? An algorithmic approach

Roshanali, Farideh; Vedadian, Ali; Shoar, Saeed; Sandoughdaran, Saleh; Naderan, Mohammad; Mandegar, Mohammad Hosein

doi:10.1007/s10353-013-0197-9

Cited by 4 publications

(3 citation statements)

References 30 publications

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“…Notably, in their study, multivariate analysis revealed that independent predictors of operative mortality were age and recent episodes of heart failure. While our meta‐analysis found no significant differences between interventions regarding overall mortality in line with some studies of Li et al 15 and Roshanali et al, 22 the studies of Bonacchi et al, 13 Milano et al, 20 and Sadeghian et al 23 found significantly higher mortality rate in RPL patients.…”

Section: Discussionsupporting

confidence: 87%

Mitral valve repair versus replacement in severe ischemic mitral regurgitation systematic review and meta‐analysis

Gamal

El-Fiky

Gamea

et al. 2022

Journal of Cardiac Surgery

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Background and Aim Ischemic mitral regurgitation (IMR) is a serious consequence of coronary artery disease. The choice of the optimal surgical strategy remains debatable. The aim of the present meta‐analysis is to compare the outcomes of mitral valve repair (RPR) versus replacement (RPL) regarding perioperative mortality, overall mortality, reoperation, recurrence of MR, and reverse remodeling after surgery. Methods Electronic searches were performed using the searchable databases of Google Scholar, Pubmed, and Embase, and the search terms mitral valve, IMR, RPR, RPL, and coronary artery bypass grafting. The main outcomes of interest are perioperative mortality, overall mortality, reoperation, recurrence of MR, and reverse remodeling after surgery. Perioperative mortality was defined as death during the surgery or within 30 days after the operation. Results There was a trend towards better perioperative survival in the RPR arm. However, the difference fell short of statistical significance [odds ratio (OR) (95% confidence interval [CI]): 0.66 (0.41–1.07), p = 0.09]. Patients submitted to RPR experienced a significantly higher MR recurrence rate when compared with their counterparts submitted to RPL [OR (95% CI): 16.8 (5.07–55.7, p = 0.00001)]. Conclusion There is a trend towards lower perioperative mortality in RPR in comparison to RPL. On the other hand, RPL was associated with significantly lower recurrence rates.

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Section: Discussionsupporting

confidence: 87%

Mitral valve repair versus replacement in severe ischemic mitral regurgitation systematic review and meta‐analysis

Gamal

El-Fiky

Gamea

et al. 2022

Journal of Cardiac Surgery

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“…On the basis of title and abstracts, 34 articles were selected and reviewed in full. Eleven articles met the inclusion and exclusion criteria [ 9 – 13 , 23 – 28 ] (Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…1 ). Of the included studies, there were ten retrospective observational studies [ 9 – 13 , 23 – 27 ] and one prospective observational study [ 28 ]. All were nonrandomized studies.…”

Section: Resultsmentioning

confidence: 99%

Repair or replace ischemic mitral regurgitation during coronary artery bypass grafting? A meta-analysis

Wang

Shi

Wen

et al. 2016

J Cardiothorac Surg

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BackgroundNo agreement has been reached for the best surgical treatment for patients with chronic ischemic mitral regurgitation (IMR) undergoing coronary artery bypass grafting (CABG). Our objective was to meta-analyze the clinical outcomes of repair and replacement.MethodsA computerized search was performed using Pubmed, Embase, Ovid medline and Cochrane Library. The search terms “ischemic or ischaemic” and “mitral valve” and “repair or replacement or annuloplasty” and “coronary artery bypass grafting” were entered as MeSH terms and keywords. The primary outcomes were operative mortality and late mortality. Secondary outcomes were 2+ or greater recurrence of mitral regurgitation and reoperation rate.ResultsEleven studies were eligible for the final meta-analysis. These studies included a total of 1750 patients, 60.4 % of whom received mitral valve repair. All patients underwent concomitant coronary artery bypass graft. No differences were found in operative mortality (summary odds ratio [OR] 0.65; 95 % confidence interval [CI] 0.43-1.00; p = 0.05), late mortality (summary hazard ratio [HR] 0.87; 95 % confidence interval [CI] 0.67-1.14; p = 0.31) and reoperation (summary odds ratio [OR] 1.47; 95 % confidence interval [CI] 0.90-2.38; p = 0.12). Regurgitation recurrence was lower in the replacement group (summary odds ratio [OR] 5.41; 95 % confidence interval [CI] 3.12-9.38; p < 0.001).ConclusionIn patients with chronic ischemic mitral regurgitation during CABG, mitral valve replacement is associated with lower recurrence of regurgitation. No differences were found regarding survival and reoperation rates.

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Surgical Treatment of Ischemic Mitral Regurgitation: Valve Repair Versus Replacement

et al. 2017

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The first randomized trial to compare MV repair versus MVR in patients with severe ischemic MR, the Cardiothoracic Surgical Trials Network (CTSN) trial, was recently concluded and reported no significant difference in the primary outcome of left ventricular end systolic volume index between the two approaches at either 1- or 2-year follow-ups. Data comparing approaches of MV repair and MVR for ischemic MR is largely limited to small, non-randomized retrospective trials. The only randomized trial data to examine this issue suggested no difference in mortality with either MVR or MV repair; however, MVR was shown to be consistently associated with higher rates of MR recurrence. Certain echocardiographic features have been reported to predict poor outcomes with MVR and may help refine the selection of the surgical approach in the individual patient.

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When to repair ischemic mitral valve regurgitation? An algorithmic approach

Cited by 4 publications

References 30 publications

Mitral valve repair versus replacement in severe ischemic mitral regurgitation systematic review and meta‐analysis

Mitral valve repair versus replacement in severe ischemic mitral regurgitation systematic review and meta‐analysis

Repair or replace ischemic mitral regurgitation during coronary artery bypass grafting? A meta-analysis

Surgical Treatment of Ischemic Mitral Regurgitation: Valve Repair Versus Replacement

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