Li Qi, Liang Meiling, Gao Mingyou, Liu Weida, Bie Dongyun, Luo Xinlin
Department of Cardiology, Fuwai Shenzhen Hospital, Chinese Academy of Medical Sciences, Shenzhen, Guangdong, P.R. China.
Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, P.R. China.
Int J Surg. 2025 Sep 17. doi: 10.1097/JS9.0000000000003170.
Treatments for ischemic mitral regurgitation (IMR) include coronary artery bypass grafting combined with mitral valve replacement (CABG + MVR), percutaneous coronary intervention (PCI) alone, and PCI combined with transcatheter edge-to-edge repair (TEER), but comparative evidence remains limited. We aimed to systematically evaluate perioperative characteristics, in-hospital and long-term outcomes of these strategies.
This PRISMA 2020-compliant systematic review and meta-analysis searched PubMed, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov through 12 November 2024. We included studies reporting outcomes for CABG + MVR, PCI alone, or PCI + TEER in IMR, excluding non-human studies, reviews, case reports, editorials, etc. The endpoints included in-hospital/30-day mortality, long-term mortality, cardiovascular mortality, procedural metrics (cardiopulmonary bypass and cross-clamp time), hospital stay, ICU stay, reoperation, readmission, cerebrovascular events, atrial fibrillation, and low cardiac output syndrome (LCOS). Data were pooled using random-effects models.
Thirty-three studies (1 randomized controlled trial, 32 cohorts; n = 3001 patients: 1355 CABG + MVR, 1617 PCI, and 29 PCI + TEER) were analyzed. In-hospital/30-day mortality was 13.8% (95% CI 3.9%-31.7%) for PCI + TEER, 11.8% (95% CI 8.4%-16.5%) for CABG + MVR, and 9.4% (95% CI 7.7%-11.5%) for PCI. Five-year mortality was 37.5% for CABG + MVR vs. 41.8% for PCI. The pooled cardiopulmonary bypass and cross-clamp time for CABG + MVR was 140.2 minutes and 101.0 minutes, respectively. PCI + TEER had shorter hospital stays (17.3 days) than CABG + MVR (22.4 days). Hospital/30-day intra-aortic balloon pump rate was lower in CABG + MVR (7.9%) than PCI + TEER (24.1%). 30-day/in-hospital complications included cerebrovascular events (CABG + MVR: 4.1%, PCI: 0.7%), atrial fibrillation (CABG + MVR: 22.9%), and LCOS (CABG + MVR: 19.6%). One-year readmission and 10-year reoperation rates post-CABG + MVR were 7.4% and 31.1%, respectively.
CABG + MVR demonstrated superior long-term survival and lower cardiovascular mortality than PCI but carried higher perioperative risks and complication rates. PCI + TEER showed shorter hospital stays but insufficient data to assess long-term efficacy. Treatment selection requires balancing comorbidities, surgical risk, and MR severity through multidisciplinary decision-making. Robust comparative trials are needed to optimize IMR management.
