ReviewCoronary Artery Bypass Grafting Versus Combined Coronary Artery Bypass Grafting and Mitral Valve Repair in Treating Ischaemic Mitral Regurgitation: A Meta-analysis
Introduction
Ischaemic mitral regurgitation (IMR) is a common complication after myocardial infarction (MI) with normal leaflet and chordal morphology, frequently following an inferior MI [1]. Nowadays, it is still controversial in the management of mild to moderate IMR at the time of coronary artery bypass grafting (CABG). There are several studies suggesting that isolated CABG (without mitral valve repair (MVR)) suffices, with dramatic improvement in ejection fraction, degree of mitral regurgitation (MR) and long-term survival [2], [3]. But other authors advocating MVR at the time of CABG have suggested that CABG alone will not correct moderate IMR in many patients, especially those with annular and ventricular dilation [4], [5], [6].
Therefore, we conducted a meta-analysis of the evidence obtained from published studies to compare the impact of CABG alone versus combined CABG and MVR in treating patients with IMR, which we thought can provide useful clinical evidence for the surgery management in treating IMR patients.
Section snippets
Methods
We performed this analysis according to the guidelines of the meta-analysis of observational studies in epidemiology group (MOOSE) [7].
Articles
Fifteen records were identified by the primary literature search. However, finally five studies [5], [15], [16], [17], [18] were included in this analysis, the other 10 studies were excluded because they were either laboratory studies, review articles, or irrelevant to the current analysis (Fig. 1). There were altogether 1038 patients included, with the publication year ranging from 2004 to 2009. The characteristics of each study are depicted in Table 2.
In the five included articles, four of
Discussion
IMR is not caused by intrinsic disease of the valve, but by left ventricular (LV) remodelling, dilation and dysfunction leading to geometric reconfiguration of the mitroventricular apparatus, which is strongly associated with poor outcomes in patients with advanced coronary artery disease [21], [22], [23], [24], [25], [26]. Adding MVR to patients with IMR still remains controversial, and the outcome is also unclear. [1], [19], [27], [28], [29], [30], [31], [32] For 1+ MR or less, most authors
Disclosure
The authors declare no conflict of interest.
Acknowledgments
We thank Dr. Xue Qian and Dr. Li Wei for their assistance in preparation of this manuscript and for their valuable advices on editing the manuscript.
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