Wang Yushu, Shi Xiuli, Wen Meiqin, Chen Yucheng, Zhang Qing
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
J Cardiothorac Surg. 2016 Sep 1;11(1):141. doi: 10.1186/s13019-016-0536-6.
No 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.
A 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.
Eleven 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).
In 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.
对于接受冠状动脉旁路移植术（CABG）的慢性缺血性二尖瓣反流（IMR）患者，最佳手术治疗方案尚未达成共识。我们的目的是对二尖瓣修复和置换的临床结果进行荟萃分析。
使用PubMed、Embase、Ovid医学数据库和Cochrane图书馆进行计算机检索。检索词“缺血性”和“二尖瓣”以及“修复或置换或瓣环成形术”和“冠状动脉旁路移植术”作为医学主题词和关键词输入。主要结局是手术死亡率和晚期死亡率。次要结局是二尖瓣反流复发2级或更高以及再次手术率。
11项研究符合最终荟萃分析的条件。这些研究共纳入1750例患者，其中60.4%接受了二尖瓣修复。所有患者均接受了同期冠状动脉旁路移植术。在手术死亡率（汇总比值比[OR]0.65；95%置信区间[CI]0.43 - 1.00；p = 0.05）、晚期死亡率（汇总风险比[HR]0.87；95%置信区间[CI]0.67 - 1.14；p = 0.31）和再次手术（汇总比值比[OR]1.47；95%置信区间[CI]0.90 - 2.38；p = 0.12）方面未发现差异。置换组的反流复发率较低（汇总比值比[OR]5.41；95%置信区间[CI]3.12 - 9.38；p < 0.001）。
在CABG期间患有慢性缺血性二尖瓣反流的患者中，二尖瓣置换与较低的反流复发相关。在生存率和再次手术率方面未发现差异。
