Surgical Repair of Moderate Ischemic Mitral Regurgitation—A Systematic Review and Meta-analysis

Mahesh Anantha Narayanan, Saurabh Aggarwal, Yogesh N V Reddy, Venkata (Mahesh) Alla, Janani Baskaran, Arun Kanmanthareddy, Rakesh M. Suri

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction Moderate mitral regurgitation (MR) of ischemic etiology has been associated with worse outcomes after coronary artery bypass grafting (CABG). Studies comparing concomitant mitral valve replacement/repair (MVR/Re) with CABG and standalone CABG have reported conflicting results. We performed a systematic review and meta-analysis of the published literature. Patients and Methods We searched using PubMed, Cochrane, EMBASE, CINAHL, and Google scholar databases from January 1960 to June 2016 for clinical trials comparing CABG to CABG + MVR/Re for moderate MR. Pooled risk ratio or mean difference (MD) with 95% confidence intervals (CI) for individual outcomes were calculated using random effects model and heterogeneity was assessed using Cochrane's Q-statistic. Results A total of 11 studies were included. Mean follow-up was 35.3 months. All-cause mortality (Mantel–Haenszel [MH] risk ratio [RR]: 0.96, 95% CI: 0.75–1.24, p = 0.775), early mortality (MH RR: 0.65, 95% CI: 0.39–1.07, p = 0.092), and stroke rates (MH RR 0.65, 95% CI: 0.21–2.03, p = 0.464) were similar between CABG and CABG + MVR/Re groups. Adverse event at follow-up was lower with CABG (MH RR: 0.90, 95% CI: 0.61–1.32, p = 0.584). MD of change from baseline in left ventricular (LV) end-systolic dimension (MD: − 2.50, 95% CI: − 5.21 to − 0.21, p = 0.071) and LV ejection fraction (MD: 0.48, 95% CI: − 2.48 to 3.44, p = 0.750) were not significantly different between the groups. Incidence of moderate MR (MH RR: 3.24, 95% CI: 1.79–5.89, p < 0.001) was higher in the CABG only group. Conclusion Addition of MVR/Re to CABG in patients with moderate ischemic MR did not result in improvement in early or overall mortality, stroke risk, or intermediate markers of LV function when compared with CABG alone.

Original languageEnglish (US)
JournalThoracic and Cardiovascular Surgeon
DOIs
StateAccepted/In press - Nov 6 2016

Fingerprint

Coronary Artery Bypass
Meta-Analysis
Confidence Intervals
Odds Ratio
Mitral Valve Insufficiency
Mitral Valve
Mortality
Stroke
Left Ventricular Function
PubMed
Stroke Volume
Clinical Trials
Databases
Incidence

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Anantha Narayanan, M., Aggarwal, S., Reddy, Y. N. V., Alla, V. M., Baskaran, J., Kanmanthareddy, A., & Suri, R. M. (Accepted/In press). Surgical Repair of Moderate Ischemic Mitral Regurgitation—A Systematic Review and Meta-analysis. Thoracic and Cardiovascular Surgeon. https://doi.org/10.1055/s-0036-1598012

Surgical Repair of Moderate Ischemic Mitral Regurgitation—A Systematic Review and Meta-analysis. / Anantha Narayanan, Mahesh; Aggarwal, Saurabh; Reddy, Yogesh N V; Alla, Venkata (Mahesh); Baskaran, Janani; Kanmanthareddy, Arun; Suri, Rakesh M.

In: Thoracic and Cardiovascular Surgeon, 06.11.2016.

Research output: Contribution to journalArticle

Anantha Narayanan, Mahesh ; Aggarwal, Saurabh ; Reddy, Yogesh N V ; Alla, Venkata (Mahesh) ; Baskaran, Janani ; Kanmanthareddy, Arun ; Suri, Rakesh M. / Surgical Repair of Moderate Ischemic Mitral Regurgitation—A Systematic Review and Meta-analysis. In: Thoracic and Cardiovascular Surgeon. 2016.
@article{2a52184446e246ee9478d3938650112f,
title = "Surgical Repair of Moderate Ischemic Mitral Regurgitation—A Systematic Review and Meta-analysis",
abstract = "Introduction Moderate mitral regurgitation (MR) of ischemic etiology has been associated with worse outcomes after coronary artery bypass grafting (CABG). Studies comparing concomitant mitral valve replacement/repair (MVR/Re) with CABG and standalone CABG have reported conflicting results. We performed a systematic review and meta-analysis of the published literature. Patients and Methods We searched using PubMed, Cochrane, EMBASE, CINAHL, and Google scholar databases from January 1960 to June 2016 for clinical trials comparing CABG to CABG + MVR/Re for moderate MR. Pooled risk ratio or mean difference (MD) with 95{\%} confidence intervals (CI) for individual outcomes were calculated using random effects model and heterogeneity was assessed using Cochrane's Q-statistic. Results A total of 11 studies were included. Mean follow-up was 35.3 months. All-cause mortality (Mantel–Haenszel [MH] risk ratio [RR]: 0.96, 95{\%} CI: 0.75–1.24, p = 0.775), early mortality (MH RR: 0.65, 95{\%} CI: 0.39–1.07, p = 0.092), and stroke rates (MH RR 0.65, 95{\%} CI: 0.21–2.03, p = 0.464) were similar between CABG and CABG + MVR/Re groups. Adverse event at follow-up was lower with CABG (MH RR: 0.90, 95{\%} CI: 0.61–1.32, p = 0.584). MD of change from baseline in left ventricular (LV) end-systolic dimension (MD: − 2.50, 95{\%} CI: − 5.21 to − 0.21, p = 0.071) and LV ejection fraction (MD: 0.48, 95{\%} CI: − 2.48 to 3.44, p = 0.750) were not significantly different between the groups. Incidence of moderate MR (MH RR: 3.24, 95{\%} CI: 1.79–5.89, p < 0.001) was higher in the CABG only group. Conclusion Addition of MVR/Re to CABG in patients with moderate ischemic MR did not result in improvement in early or overall mortality, stroke risk, or intermediate markers of LV function when compared with CABG alone.",
author = "{Anantha Narayanan}, Mahesh and Saurabh Aggarwal and Reddy, {Yogesh N V} and Alla, {Venkata (Mahesh)} and Janani Baskaran and Arun Kanmanthareddy and Suri, {Rakesh M.}",
year = "2016",
month = "11",
day = "6",
doi = "10.1055/s-0036-1598012",
language = "English (US)",
journal = "Thoracic and Cardiovascular Surgeon",
issn = "0171-6425",
publisher = "Georg Thieme Verlag",

}

TY - JOUR

T1 - Surgical Repair of Moderate Ischemic Mitral Regurgitation—A Systematic Review and Meta-analysis

AU - Anantha Narayanan, Mahesh

AU - Aggarwal, Saurabh

AU - Reddy, Yogesh N V

AU - Alla, Venkata (Mahesh)

AU - Baskaran, Janani

AU - Kanmanthareddy, Arun

AU - Suri, Rakesh M.

PY - 2016/11/6

Y1 - 2016/11/6

N2 - Introduction Moderate mitral regurgitation (MR) of ischemic etiology has been associated with worse outcomes after coronary artery bypass grafting (CABG). Studies comparing concomitant mitral valve replacement/repair (MVR/Re) with CABG and standalone CABG have reported conflicting results. We performed a systematic review and meta-analysis of the published literature. Patients and Methods We searched using PubMed, Cochrane, EMBASE, CINAHL, and Google scholar databases from January 1960 to June 2016 for clinical trials comparing CABG to CABG + MVR/Re for moderate MR. Pooled risk ratio or mean difference (MD) with 95% confidence intervals (CI) for individual outcomes were calculated using random effects model and heterogeneity was assessed using Cochrane's Q-statistic. Results A total of 11 studies were included. Mean follow-up was 35.3 months. All-cause mortality (Mantel–Haenszel [MH] risk ratio [RR]: 0.96, 95% CI: 0.75–1.24, p = 0.775), early mortality (MH RR: 0.65, 95% CI: 0.39–1.07, p = 0.092), and stroke rates (MH RR 0.65, 95% CI: 0.21–2.03, p = 0.464) were similar between CABG and CABG + MVR/Re groups. Adverse event at follow-up was lower with CABG (MH RR: 0.90, 95% CI: 0.61–1.32, p = 0.584). MD of change from baseline in left ventricular (LV) end-systolic dimension (MD: − 2.50, 95% CI: − 5.21 to − 0.21, p = 0.071) and LV ejection fraction (MD: 0.48, 95% CI: − 2.48 to 3.44, p = 0.750) were not significantly different between the groups. Incidence of moderate MR (MH RR: 3.24, 95% CI: 1.79–5.89, p < 0.001) was higher in the CABG only group. Conclusion Addition of MVR/Re to CABG in patients with moderate ischemic MR did not result in improvement in early or overall mortality, stroke risk, or intermediate markers of LV function when compared with CABG alone.

AB - Introduction Moderate mitral regurgitation (MR) of ischemic etiology has been associated with worse outcomes after coronary artery bypass grafting (CABG). Studies comparing concomitant mitral valve replacement/repair (MVR/Re) with CABG and standalone CABG have reported conflicting results. We performed a systematic review and meta-analysis of the published literature. Patients and Methods We searched using PubMed, Cochrane, EMBASE, CINAHL, and Google scholar databases from January 1960 to June 2016 for clinical trials comparing CABG to CABG + MVR/Re for moderate MR. Pooled risk ratio or mean difference (MD) with 95% confidence intervals (CI) for individual outcomes were calculated using random effects model and heterogeneity was assessed using Cochrane's Q-statistic. Results A total of 11 studies were included. Mean follow-up was 35.3 months. All-cause mortality (Mantel–Haenszel [MH] risk ratio [RR]: 0.96, 95% CI: 0.75–1.24, p = 0.775), early mortality (MH RR: 0.65, 95% CI: 0.39–1.07, p = 0.092), and stroke rates (MH RR 0.65, 95% CI: 0.21–2.03, p = 0.464) were similar between CABG and CABG + MVR/Re groups. Adverse event at follow-up was lower with CABG (MH RR: 0.90, 95% CI: 0.61–1.32, p = 0.584). MD of change from baseline in left ventricular (LV) end-systolic dimension (MD: − 2.50, 95% CI: − 5.21 to − 0.21, p = 0.071) and LV ejection fraction (MD: 0.48, 95% CI: − 2.48 to 3.44, p = 0.750) were not significantly different between the groups. Incidence of moderate MR (MH RR: 3.24, 95% CI: 1.79–5.89, p < 0.001) was higher in the CABG only group. Conclusion Addition of MVR/Re to CABG in patients with moderate ischemic MR did not result in improvement in early or overall mortality, stroke risk, or intermediate markers of LV function when compared with CABG alone.

UR - http://www.scopus.com/inward/record.url?scp=85010664739&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85010664739&partnerID=8YFLogxK

U2 - 10.1055/s-0036-1598012

DO - 10.1055/s-0036-1598012

M3 - Article

JO - Thoracic and Cardiovascular Surgeon

JF - Thoracic and Cardiovascular Surgeon

SN - 0171-6425

ER -