目的:缺血性二尖瓣反流(IMR)与死亡率和心力衰竭风险增加相关。然而,适度IMR的优化管理仍存在争议。我们进行了一项荟萃分析,以评估在冠状动脉旁路移植术(CABG)期间是否应纠正中度IMR。
方法:我们搜索了PubMed,Embase,和Cochrane数据库从开始到2022年10月15日,用于评估中度IMR患者中单独CABG与二尖瓣(MV)手术的CABG的研究。主要结果是围手术期死亡率。
结果:纳入了4项随机对照试验和3项观察性研究,其倾向数据匹配,包括1209例患者单独评估CABG(n=598)和CABG合并MV手术(n=611)。与单独的CABG相比,增加MV手术并没有显著增加围手术期死亡率(RR,1.01;95%CI,0.52-1.96;p=0.98)和卒中(RR,2.14;95%CI,0.97-4.72;p=0.06),而更长的体外循环持续时间(MD,54.91;95%CI,42.13-67.68;p<0.01),在联合手术组中观察到肾功能衰竭的发生率增加。在后续行动中,增加MV手术与残余MR率降低显著相关(RR,0.26;95%CI,0.13-0.51;p<0.01)和NYHAIII-IV级(RR,0.54;95%CI,0.37-0.78;p<0.01)。然而,中期死亡率(RR,1.05;95%CI,0.65-1.70;p=0.82)或晚期死亡率(RR,91;95%CI,0.49-1.71;p=0.78)在单独CABG组和联合手术组之间。
结论:中度IMR患者,在CABG基础上加用MV手术并没有增加围手术期死亡率.尽管在随访中中度MR和NYHAIII-IV级的比率降低,增加MV手术并不能降低中期或晚期死亡率.
OBJECTIVE: Ischemic mitral regurgitation (IMR) is associated with increased risks of mortality and heart failure. However, the optimal management of moderate IMR remains controversial. We conducted a meta-analysis to appraise whether moderate IMR should be corrected during coronary artery bypass grafting (CABG).
METHODS: We searched PubMed, Embase, and Cochrane databases from its inception up to 15 October 2022 for studies that assessed CABG alone versus CABG with mitral valve (MV) surgery in patients with moderate IMR. The primary outcome was perioperative mortality.
RESULTS: Four randomized controlled trials and three observational studies with propensity-matched data including 1209 patients assessing CABG alone (n = 598) versus CABG with MV surgery (n = 611) were included. Compared to CABG alone, the addition of MV surgery did not significantly increase perioperative mortality (RR, 1.01; 95% CI, 0.52-1.96; p = 0.98) and stroke (RR, 2.14; 95% CI, 0.97-4.72; p = 0.06), whereas a longer cardiopulmonary bypass duration (MD, 54.91; 95% CI, 42.13-67.68; p < 0.01) and an increased incidence of renal failure were observed in the combined-procedure group. At follow-up, the addition of MV surgery was significantly associated with reduced rates of residual MR (RR, 0.26; 95% CI, 0.13-0.51; p < 0.01) and NYHA class III-IV (RR, 0.54; 95% CI, 0.37-0.78; p < 0.01). However, there was no difference in either mid-term mortality (RR, 1.05; 95% CI, 0.65-1.70; p = 0.82) or late mortality (RR, 91; 95% CI, 0.49-1.71; p = 0.78) between the CABG alone group and the combined-procedure group.
CONCLUSIONS: In patients with moderate IMR, the addition of MV surgery to CABG did not increase perioperative mortality. Despite the reduced rates of moderate MR and NYHA class III-IV at follow-up, the addition of MV surgery did not translate in a reduction in mid-term or late mortality.