ObjectiveTo systematically evaluate the therapeutic effects of different surgical procedures for ischemic mitral regurgitation (IMR). MethodsComputer searches were conducted in CNKI, Wanfang, VIP, CBM, PubMed, The Cochrane Library, EMbase, and Web of Science, with the search time limit from the inception of the databases to February 2024. Two researchers independently screened the literature, extracted data, used the Cochrane bias risk assessment tool to evaluate the quality of the included studies, and used Stata 17.0 software to analyze the data. ResultsA total of 19 randomized controlled trials involving 6139 patients were finally included, involving six surgical procedures, and the overall quality of the included studies was relatively high. The results of the network Meta-analysis showed that the 30-day all-cause mortality rate of mitral valve repair (MVr) was significantly lower than that of coronary artery bypass grafting (CABG) [OR=0.24, 95%CI (0.07, 0.87)], mitral valve replacement (MVR) [OR=0.43, 95%CI (0.23, 0.79)], CABG+MVR [OR=0.21, 95%CI (0.04, 0.95)] and transcatheter mitral valve edge-to-edge repair (TEER) using MitraClip [OR=0.13, 95%CI (0.02, 0.87)]. The 30-day all-cause mortality rate of CABG+MVr was significantly lower than that of CABG [OR=0.56, 95%CI (0.33, 0.93)] and CABG+MVR [OR=0.48, 95%CI (0.24, 0.94)], and the best probability ranking results showed that MVR might be the most effective in reducing the 30-day all-cause mortality rate. The incidence of renal complications in CABG+MVr was significantly lower than that in CABG+MVR [OR=0.42, 95%CI (0.21, 0.83)]; the best probability ranking results showed that CABG+MVr might be the most effective in reducing renal complications. ConclusionThe current limited evidence suggests that CABG+MVr and MVR may be the best surgical intervention methods for IMR patients at present. Due to the limitations of the number and quality of included studies, the above conclusions still need to be verified by more high-quality studies.
Objective To systematically evaluate the impact of pulmonary hypertension (PH) on the prognosis of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Methods We conducted a computer-based search of databases including CNKI, WanFang Data, VIP, CBM, PubMed, The Cochrane Library, EMbase and Web of Science from the inception of the databases to June 2023. Two reviewers independently screened articles, extracted data and assessed the quality of the included studies. Meta-analysis was performed using Stata 17.0 software. Results A total of 16 cohort studies with Newcastle-Ottawa Scale score≥7 were included. Meta-analysis results demonstrated that patients with PH who underwent TAVR had significantly higher rates of all-cause mortality at 1 year [OR=2.10, 95%CI (1.60, 2.75), P＜0.01, I2=75%], 30 days [OR=2.09, 95%CI (1.54, 2.83), P＜0.01, I2=33%] and cardiovascular mortality [OR=1.49, 95%CI (1.18, 1.90), P＜0.001, I2=41%], compared to those without PH. There was no statistical difference between the two groups in major bleeding events, stroke, myocardial infarction, pacemaker implantation or postoperative renal failure. Subgroup analysis was conducted for some outcome indicators with significant heterogeneity from the aspects of PH measurement methods, PH diagnostic criteria and different PH types, and the results showed that most outcome indicators were subcombined and the direction was consistent with the overall result, and the heterogeneity was significantly reduced. Conclusion PH can significantly increase the 30 days, 1-year, and cardiovascular mortality rates in severe AS patients undergoing TAVR surgery.