Treatment options for ischemic mitral regurgitation: A meta-analysis

J Thorac Cardiovasc Surg. 2022 Feb;163(2):607-622.e14. doi: 10.1016/j.jtcvs.2020.05.041. Epub 2020 May 27.

Abstract

Background: Treatment of ischemic mitral regurgitation (IMR) is in evolution, as percutaneous procedures and complex surgical repair have been recently investigated in randomized clinical trials and matched studies. This study aims to review and compare the current treatment options for IMR.

Methods: A comprehensive literature search was conducted using electronic databases. The primary outcome was all-cause long-term mortality. The secondary outcomes were perioperative mortality, unplanned rehospitalization, reoperation, and composite end points as defined in the original articles.

Results: A total of 12 articles met the inclusion criteria and were included in the final meta-analysis. The MitraClip procedure did not confer a significant benefit in mortality and repeated hospitalization compared with medical therapy alone. In patients with moderate IMR, the adjunct of mitral procedure over coronary artery bypass graft is not associated with clinical improvements. When evaluating mitral valve (MV) replacement versus repair, hospital mortality was greater among patients undergoing replacement (odds ratio [OR], 1.91; P = .009), but both reoperation and readmission rates were lower (OR, 0.60, P = .05; and OR, 0.45, P < .02, respectively). Comparing restrictive annuloplasty alone with adjunctive subvalvular repair, subvalvular procedures resulted in fewer readmissions (OR, 0.50; P = .06) and adverse composite end points (P = .009).

Conclusions: MitraClip procedure is not associated with improved outcomes compared with medical therapy. MV replacement is associated with increased early mortality but reduced reoperation rate and readmission rate compared with MV repair using annuloplasty in moderate-to-severe IMR. Despite no significant benefit in isolated outcomes comparing annular and adjunct subvalvular procedures, the adjunct of subvalvular procedures reduces the risk of major postoperative adverse events.

Keywords: ischemic mitral regurgitation; mitral valve; mitral valve repair; mitral valve replacement.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Video-Audio Media

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cardiovascular Agents / adverse effects
  • Cardiovascular Agents / therapeutic use*
  • Female
  • Heart Valve Prosthesis
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Heart Valve Prosthesis Implantation* / instrumentation
  • Heart Valve Prosthesis Implantation* / mortality
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve / physiopathology
  • Mitral Valve / surgery*
  • Mitral Valve Annuloplasty* / adverse effects
  • Mitral Valve Annuloplasty* / instrumentation
  • Mitral Valve Annuloplasty* / mortality
  • Mitral Valve Insufficiency / etiology
  • Mitral Valve Insufficiency / mortality
  • Mitral Valve Insufficiency / physiopathology
  • Mitral Valve Insufficiency / therapy*
  • Myocardial Ischemia / complications*
  • Myocardial Ischemia / mortality
  • Myocardial Ischemia / physiopathology
  • Patient Readmission
  • Postoperative Complications / mortality
  • Postoperative Complications / surgery
  • Prosthesis Design
  • Recovery of Function
  • Reoperation
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome

Substances

  • Cardiovascular Agents