Yin Liang, Wang Zhinong, Shen Hua, Min Jie, Ling Xinyu, Xi Wang
Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
Heart Lung Circ. 2014 Oct;23(10):905-12. doi: 10.1016/j.hlc.2014.03.031. Epub 2014 Apr 18.
Ischaemic mitral regurgitation (IMR) is commonly manifested after coronary artery disease, but it is still controversial as to whether coronary artery bypass grafting (CABG) alone improves postoperative outcome.
A focussed clinical question was designed and a meta-analysis of published studies was performed to identify the impact of mitral valve repair (MVR) in patients with IMR undergoing CABG versus those undergoing CABG alone.
Using the Medline database, the Cochrane clinical trials database and online clinical trial databases, we reviewed all RCTs and observational studies examining the impact of MVR and CABG in treating patients with IMR. We searched for literature published before September 2013 and earlier.
This analysis identified five studies which examined the impact of CABG alone versus combined CABG and MVR in treating patients with IMR, involving 1038 patients, with 423 patients undergoing CABG alone and 615 were performed combined CABG and MVR procedures. There was significant improvement in postoperative mitral regurgitation (MR) grade in combined group, comparing with CABG alone group (WMD: 1.34, 95% CI: 0.47 to 2.21, p = 0.003), but no significant differences were noted between the CABG plus MVR group and CABG alone group in terms of in-hospital mortality (OR: 0.84, 95% CI: 0.44 to 1.61, p = 0.60), MR grade improvement rate (OR: 0.19, 95% CI: 0.02 to 1.66, p = 0.13), postoperative mean NYHA functional class (WMD: 0.33, 95% CI: -0.29 to 0.94, p = 0.30) and five-year survival (OR: 0.77, 95% CI: 0.34 to 1.73, p = 0.53).
Compared with CABG alone, patients who underwent combined CABG and MVR procedures showed a greater improvement in postoperative MR grade, but in terms of in-hospital mortality, MR grade improvement rate, postoperative mean NYHA functional class and five-year survival, adding MVR to CABG surgery lacks evidence to show its superiority.
缺血性二尖瓣反流（IMR）常见于冠状动脉疾病之后，但冠状动脉旁路移植术（CABG）单独应用是否能改善术后结局仍存在争议。
设计一个重点临床问题，并对已发表的研究进行荟萃分析，以确定二尖瓣修复术（MVR）对接受CABG的IMR患者与单纯接受CABG的患者的影响。
利用Medline数据库、Cochrane临床试验数据库和在线临床试验数据库，我们检索了所有检验MVR和CABG对IMR患者治疗影响的随机对照试验（RCT）和观察性研究。我们搜索了2013年9月及以前发表的文献。
该分析确定了五项研究，这些研究检验了单纯CABG与CABG联合MVR对IMR患者的治疗影响，涉及1038例患者，其中423例患者单纯接受CABG，615例患者接受CABG联合MVR手术。与单纯CABG组相比，联合组术后二尖瓣反流（MR）分级有显著改善（加权均数差：1.34，95%可信区间：0.47至2.21，p = 0.003），但CABG加MVR组与单纯CABG组在院内死亡率（比值比：0.84，95%可信区间：0.44至1.61，p = 0.60）、MR分级改善率（比值比：0.19，95%可信区间：0.02至1.66，p = 0.13）、术后平均纽约心脏协会（NYHA）功能分级（加权均数差：0.33，95%可信区间：-0.29至0.94，p = 0.30）和五年生存率（比值比：0.77，95%可信区间：0.34至1.73，p = 0.53）方面无显著差异。
与单纯CABG相比，接受CABG联合MVR手术的患者术后MR分级改善更大，但在院内死亡率、MR分级改善率、术后平均NYHA功能分级和五年生存率方面，CABG手术加MVR缺乏证据表明其优越性。
