Yu Chengyuan, Arjomandi Rad Arian, He Hongbo, Yang Yichen, Maessen Jos G, Sardari Nia Peyman
Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
Medical Sciences Division, University of Oxford, Oxford, UK.
Interdiscip Cardiovasc Thorac Surg. 2025 Jun 4;40(6). doi: 10.1093/icvts/ivaf109.
Recurrent mitral regurgitation (MR) is typically defined as MR that is moderate or severe on follow-up echocardiography after the intervention. This meta-analysis summarizes the results of all available studies on the impact of recurrent MR on clinical outcomes after the intervention.
Medline, EMBASE, PubMed and Web of Science were searched from January 2000 to August 2024 for original studies reporting outcomes about the clinical impact of recurrent MR. Five clinical outcomes were analysed: reoperation, cardiovascular deaths, readmission, heart failure and New York Heart Association (NYHA) functional classification. The summary odds ratio (OR) with the 95% confidence interval (CI) was used to assess the risk of clinical outcomes.
A total of 22 studies were included in the final analysis, involving 5,804 patients, of which 960 had recurrent MR. The overall pooled incidence of recurrent MR is 16.54%. Secondary or primary patients with MR with recurrent MR after an intervention had higher rates of reoperation [(OR = 6.25, 95% CI, 2.95-14.41; P < 0.001) or (OR = 22.54, 95% CI, 14.96-33.98; P < 0.001)]or of cardiovascular death [(OR = 5.26, 95% CI, 2.35-11.77; P < 0.001) or (OR = 1.68, 95% CI, 1.32-2.14; P < 0.001)]. The rates were also high for readmission (OR = 3.95, 95% CI, 2.56-6.10; P < 0.001), heart failure incidence (OR = 2.87, 95% CI, 1.75-5.11; P < 0.001) and the number of NYHA functional class III/IV (OR = 5.40, 95% CI, 3.01-9.70; P < 0.001) for recurrent MR of secondary MR. However, no significant association was found between recurrent MR of primary MR and the incidence of NYHA functional class III/IV (OR = 1.02, 95% CI, 0.47-2.22; P = 0.96).
Recurrent MR is associated with higher rates of reoperations, readmissions, cardiovascular deaths, incidences of heart failure and NYHA functional class III/IV numbers. However, recurrent MR of primary MR is not correlated with NYHA functional class III/IV.
复发性二尖瓣反流（MR）通常定义为干预后随访超声心动图显示为中度或重度的MR。本荟萃分析总结了所有关于复发性MR对干预后临床结局影响的现有研究结果。
检索了2000年1月至2024年8月期间的Medline、EMBASE、PubMed和Web of Science，以查找报告复发性MR临床影响结局的原始研究。分析了五项临床结局：再次手术、心血管死亡、再入院、心力衰竭和纽约心脏协会（NYHA）功能分级。采用汇总比值比（OR）及95%置信区间（CI）评估临床结局风险。
最终分析共纳入22项研究，涉及5804例患者，其中960例有复发性MR。复发性MR的总体合并发生率为16.54%。干预后出现复发性MR的继发性或原发性MR患者再次手术率更高[（OR = 6.25，95% CI，2.95 - 14.41；P < 0.001）或（OR = 22.54，95% CI，14.96 - 33.98；P < 0.001）]，或心血管死亡率更高[（OR = 5.26，95% CI，2.35 - 11.77；P < 0.001）或（OR = 1.68，95% CI，1.32 - 2.14；P < 0.001）]。继发性MR复发性MR的再入院率（OR = 3.95，95% CI，2.56 - 6.10；P < 0.001）、心力衰竭发生率（OR = 2.87，95% CI，1.75 - 5.11；P < 0.001）以及NYHA功能分级III/IV级的数量（OR = 5.40，95% CI，3.01 - 9.70；P < 0.001）也较高。然而，原发性MR的复发性MR与NYHA功能分级III/IV级的发生率之间未发现显著关联（OR = 1.02，95% CI，0.47 - 2.22；P = 0.96）。
复发性MR与更高的再次手术率、再入院率、心血管死亡率、心力衰竭发生率以及NYHA功能分级III/IV级的数量相关。然而，原发性MR的复发性MR与NYHA功能分级III/IV级无关。
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