Surgical Treatment for Patients with Coronary Artery Disease and Moderate Ischemic Mitral Regurgitation: A Systematic Review and Meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 LIUChao , GUOPeng-ju , WENBing , XUHua-shan , JIAOZhou-yang , YAOXing-xing , ZHAOWen-zeng

Department of Cardiovascular Surgery, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, P. R. China;

Corresponding author：

LIUChao, Email: liubeilun@sohu.com

Keywords：

Coronary artery disease; Ischemic mitral regurgitation; Surgery; Meta-analysis

DOI：

10.7507/1007-4848.20140021

Video：

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Objective To evaluate clinical outcomes of mitral valve replacement (MVR) combined with coronary artery bypass grafting (CABG) compared with CABG alone for patients with coronary artery disease and moderate ischemic mitral regurgitation (IMR). Methods A systematic literature search for studies which were published from January 1990 to August 2013 from PubMed, Cochrane Library, China Academic Journals Full-text Database, Wanfang Data, and VIP Journal Database and compared CABG+MVR and CABG alone for IMR patients was performed. Quality of randomized controlled trials was assessed by Jada scale. Quality of case control studies was assessed by Newcastle-Ottawa Scale (NOS). RevMan 5.0 was used for meta-analysis. Results Six clinical trials including 2 randomized controlled trials and 4 case control studies were included in this study. Jadad scale for both 2 randomized controlled trials was 5 points and NOS for all the 4 case controlled studies was 8 points. Meta-analysis showed that there was no statistical difference in early postoperative mortality between the 2 groups[randomized controlled trials:RR=1.69, 95% CI (0.28, 10.10), P=0.57;case controlled studies:OR=0.48, 95% CI (0.21, 1.13), P=0.09]. There was no statistical difference in 1-year survival rate between the 2 groups[randomized controlled trials:RR=1.00, 95% CI (0.93, 1.08), P=0.92;case controlled studies:OR=1.72, 95% CI (0.60, 4.95), P=0.32]. There was no statistical difference in 5-year survival rate between the 2 groups[OR=1.12, 95% CI (0.68, 1.83), P=0.66]. LVEF of CABG+MVR patients was significantly higher than that of CABG alone patients[MD=1.38, 95% CI (0.17, 2.59), P=0.03]. Postoperative New York Heart Association (NYHA) class of CABG+MVR patients was significantly better than that of CABG alone patients[MD=-0.85, 95% CI (-1.14, -0.56), P < 0.01]. Conclusion Compared with CABG alone, MVR combined with CABG cannot significantly increase postoperative survival rate of the patients, but can improve postoperative heart function recovery and quality of life.

Citation： LIUChao, GUOPeng-ju, WENBing, XUHua-shan, JIAOZhou-yang, YAOXing-xing, ZHAOWen-zeng. Surgical Treatment for Patients with Coronary Artery Disease and Moderate Ischemic Mitral Regurgitation: A Systematic Review and Meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(1): 80-86. doi: 10.7507/1007-4848.20140021 Copy

1.	Aronson D, Goldsher N, Zukermann R, et al.Ischemic mitral regurgitation and risk of heart failure after myocardial infarction.Arch Intern Med, 2006, 166 (21):2362-2368.
2.	Watanabe N, Ogasawara Y, Yamaura Y, et al.Mitral annulus flattens in ischemic Mr:geometric differences between inferior and anterior myocardial infarction.Circulation, 2005, 112:I458-I462.
3.	Di Mauro M, Di Giammarco G, Vitolla G, et al.Impact of no-tomoderate mitral regurgitation on late results after isolated coronary artery bypass grafting in patients with ischemic cardiomyopathy.Ann Thorac Surg, 2006, 81 (6):2128-2134.
4.	Wijns W, Kolh P, Danchin N, et al.Guidelines on myocardial revascularization:the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC)and the European Association for Cardio-Thoracic Surgery (EACTS).Eur Heart J, 2010, 31:2501-2555.
5.	Jadad AR, Moore RA, Carroll D, et al.Assessing the quality of reports of randomized clinical trials:is blinding necessary? Control Clin Trials, 1996, 17 (1):1-12.
6.	Wells G, Shea B, O'connell D, et al.NewCastle-Ottawa quallty assessment Scale-Case control studies[2013-09-30].http://www.ohri.ca/programs/clinicall_epidemiology/oxford.htm.
7.	Prifti E, Bonacchi M, Frati G, et al.Should mild-to-moderate and moderate ischemic mitral regurgitation be corrected in patients with impaired left ventricular function undergoing simultaneous coronary revascularization? J Card Surg, 2001, 16 (6):473-483.
8.	Harris KM, Sundt TM, Aeppli D, et al.Can late survival of patients with moderate ischemic mitral regurgitation be impacted by intervention on the valve? Ann Thorac Surg, 2002, 74 (5):1468-1475.
9.	Wong DR, Agnihotri AK, Hung JW, et al.Long-term survival after surgical revascularization for moderate ischemic mitral regurgitation.Ann Thorac Surg, 2005, 80 (2):570-577.
10.	Fattouch K, Guccione F, Sampognaro R, et al.POINT:efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation:a randomized trial.J Thorac Cardiovasc Surg, 2009, 138 (2):278-285.
11.	Goland S, Czer LS, Siegel RJ, et al.Coronary revascularization alone or with mitral valve repair:outcomes in patients with moderate ischemic mitral regurgitation.Tex Heart Inst J, 2009, 36 (5):416-424.
12.	Chan KM, Punjabi PP, Flather M, et al.Coronary artery bypass surgery with or without mitral valve annuloplasty in moderate functional ischemic mitral regurgitation:final results of the Randomized Ischemic Mitral Evaluation (RIME) trial.Circulation, 2012, 126 (21):2502-2510.
13.	Pierard LA, Lancellotti P.Stress testing in valve disease.Heart, 2007, 93 (6):766-772.
14.	Lapu-Bula R, Robert A, Van Craeynest D, et al.Contribution of exercise-induced mitral regurgitation to exercise stroke volume and exercise capacity in patients with left ventricular systolic dysfunction.Circulation, 2002, 106 (11):1342-1348.
15.	Gazoni LM, Kern JA, Swenson BR, et al.A change in perspective:results for ischemic mitral valve repair are similar to mitral valve repair for degenerative disease.Ann Thorac Surg, 2007, 84 (3):750-757.
16.	Soleimani M, Khazalpour M, Cheng G, et al.Moderate mitral regurgitation accelerates left ventricular remodeling after posterolateral myocardial infarction.Ann Thorac Surg, 2011, 92 (5):1614-1620.
17.	Hung J, Papakostas L, Tahta SA, et al.Mechanism of recurrent ischemic mitral regurgitation after annuloplasty:continued LV remodeling as a moving target.Circulation, 2004, 110 (11 Suppl 1):Ⅱ85-Ⅱ90.
18.	Meris A, Amigoni M, Verma A, et al.Mechanisms and predictors of mitral regurgitation after high-risk myocardial infarction.J Am Soc Echocardiogr, 2012, 25 (5):535-542.
19.	Aklog L, Filsoufi F, Flores KQ, et al.Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation? Circulation, 2001, 104 (12 Suppl 1):I68-I75.
20.	Lam BK, Gillinov AM, Blackstone EH, et al.Importance of moderate ischemic mitral regurgitation.Ann Thorac Surg, 2005, 79 (2):462-470.
21.	Kang DH, Kim MJ, Kang SJ, et al.Mitral valve repair versus revascularization alone in the treatment of ischemic mitral regurgitation.Circulation, 2006, 114 (1 Suppl):I499-I503.
22.	Unger P, Magne J, Dedobbeleer C, et al.Ischemic mitral regurgitation:not only a bystander.Curr Cardiol Rep, 2012, 14 (2):180-189.
23.	Braun J, Bax JJ, Versteegh MI, et al.Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in ischemic mitral regurgitation.Eur J Cardiothorac Surg, 2005, 27 (5):847-853.
24.	Smith PK, Michler RE, Woo YJ, et al.Design, rationale, and initiation of the Surgical Interventions for Moderate Ischemic Mitral Regurgitation Trial:a report from the Cardiothoracic Surgical Trials Network.J Thorac Cardiovasc Surg, 2012, 143 (1):111-117.

1. Aronson D, Goldsher N, Zukermann R, et al.Ischemic mitral regurgitation and risk of heart failure after myocardial infarction.Arch Intern Med, 2006, 166 (21):2362-2368.
2. Watanabe N, Ogasawara Y, Yamaura Y, et al.Mitral annulus flattens in ischemic Mr:geometric differences between inferior and anterior myocardial infarction.Circulation, 2005, 112:I458-I462.
3. Di Mauro M, Di Giammarco G, Vitolla G, et al.Impact of no-tomoderate mitral regurgitation on late results after isolated coronary artery bypass grafting in patients with ischemic cardiomyopathy.Ann Thorac Surg, 2006, 81 (6):2128-2134.
4. Wijns W, Kolh P, Danchin N, et al.Guidelines on myocardial revascularization:the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC)and the European Association for Cardio-Thoracic Surgery (EACTS).Eur Heart J, 2010, 31:2501-2555.
5. Jadad AR, Moore RA, Carroll D, et al.Assessing the quality of reports of randomized clinical trials:is blinding necessary? Control Clin Trials, 1996, 17 (1):1-12.
6. Wells G, Shea B, O'connell D, et al.NewCastle-Ottawa quallty assessment Scale-Case control studies[2013-09-30].http://www.ohri.ca/programs/clinicall_epidemiology/oxford.htm.
7. Prifti E, Bonacchi M, Frati G, et al.Should mild-to-moderate and moderate ischemic mitral regurgitation be corrected in patients with impaired left ventricular function undergoing simultaneous coronary revascularization? J Card Surg, 2001, 16 (6):473-483.
8. Harris KM, Sundt TM, Aeppli D, et al.Can late survival of patients with moderate ischemic mitral regurgitation be impacted by intervention on the valve? Ann Thorac Surg, 2002, 74 (5):1468-1475.
9. Wong DR, Agnihotri AK, Hung JW, et al.Long-term survival after surgical revascularization for moderate ischemic mitral regurgitation.Ann Thorac Surg, 2005, 80 (2):570-577.
10. Fattouch K, Guccione F, Sampognaro R, et al.POINT:efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation:a randomized trial.J Thorac Cardiovasc Surg, 2009, 138 (2):278-285.
11. Goland S, Czer LS, Siegel RJ, et al.Coronary revascularization alone or with mitral valve repair:outcomes in patients with moderate ischemic mitral regurgitation.Tex Heart Inst J, 2009, 36 (5):416-424.
12. Chan KM, Punjabi PP, Flather M, et al.Coronary artery bypass surgery with or without mitral valve annuloplasty in moderate functional ischemic mitral regurgitation:final results of the Randomized Ischemic Mitral Evaluation (RIME) trial.Circulation, 2012, 126 (21):2502-2510.
13. Pierard LA, Lancellotti P.Stress testing in valve disease.Heart, 2007, 93 (6):766-772.
14. Lapu-Bula R, Robert A, Van Craeynest D, et al.Contribution of exercise-induced mitral regurgitation to exercise stroke volume and exercise capacity in patients with left ventricular systolic dysfunction.Circulation, 2002, 106 (11):1342-1348.
15. Gazoni LM, Kern JA, Swenson BR, et al.A change in perspective:results for ischemic mitral valve repair are similar to mitral valve repair for degenerative disease.Ann Thorac Surg, 2007, 84 (3):750-757.
16. Soleimani M, Khazalpour M, Cheng G, et al.Moderate mitral regurgitation accelerates left ventricular remodeling after posterolateral myocardial infarction.Ann Thorac Surg, 2011, 92 (5):1614-1620.
17. Hung J, Papakostas L, Tahta SA, et al.Mechanism of recurrent ischemic mitral regurgitation after annuloplasty:continued LV remodeling as a moving target.Circulation, 2004, 110 (11 Suppl 1):Ⅱ85-Ⅱ90.
18. Meris A, Amigoni M, Verma A, et al.Mechanisms and predictors of mitral regurgitation after high-risk myocardial infarction.J Am Soc Echocardiogr, 2012, 25 (5):535-542.
19. Aklog L, Filsoufi F, Flores KQ, et al.Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation? Circulation, 2001, 104 (12 Suppl 1):I68-I75.
20. Lam BK, Gillinov AM, Blackstone EH, et al.Importance of moderate ischemic mitral regurgitation.Ann Thorac Surg, 2005, 79 (2):462-470.
21. Kang DH, Kim MJ, Kang SJ, et al.Mitral valve repair versus revascularization alone in the treatment of ischemic mitral regurgitation.Circulation, 2006, 114 (1 Suppl):I499-I503.
22. Unger P, Magne J, Dedobbeleer C, et al.Ischemic mitral regurgitation:not only a bystander.Curr Cardiol Rep, 2012, 14 (2):180-189.
23. Braun J, Bax JJ, Versteegh MI, et al.Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in ischemic mitral regurgitation.Eur J Cardiothorac Surg, 2005, 27 (5):847-853.
24. Smith PK, Michler RE, Woo YJ, et al.Design, rationale, and initiation of the Surgical Interventions for Moderate Ischemic Mitral Regurgitation Trial:a report from the Cardiothoracic Surgical Trials Network.J Thorac Cardiovasc Surg, 2012, 143 (1):111-117.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Treatment for Patients with Coronary Artery Disease and Moderate Ischemic Mitral Regurgitation: A Systematic Review and Meta-analysis

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