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A Meta‐Analysis of Ring Annuloplasty Versus Combined Ring Annuloplasty and Subvalvular Repair for Moderate‐to‐Severe Functional Mitral Regurgitation
Author(s) -
Mihos Christos G.,
LarrauriReyes Maiteder,
Santana Orlando
Publication year - 2016
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.12662
Subject(s) - medicine , cardiology , mitral valve repair , confidence interval , mitral regurgitation , ring (chemistry) , functional mitral regurgitation , relative risk , mitral valve , meta analysis , surgery , heart failure , ejection fraction , chemistry , organic chemistry
A BSTRACT Background A ring annuloplasty (Ring) for moderate‐to‐severe functional mitral regurgitation (MR) is associated with suboptimal outcomes, and adjunctive subvalvular repair techniques (Ring + Subvalvular) have been advocated to improve repair durability. However, the outcomes of this strategy are not clearly defined. Methods A systematic review was performed to identify studies that compared a Ring versus Ring + Subvalvular repair for the treatment of moderate‐to‐severe functional MR. A meta‐analysis was conducted on clinical outcomes and echocardiographic measures of follow‐up MR and left ventricular reverse remodeling. Risk ratio (RR) and mean difference (MD) were calculated by the Mantel–Haenszel and Inverse Variance methods under a fixed or random effects model, as appropriate. Results Seven non‐randomized studies were identified, with a total of 531 patients (Ring = 301, Ring + Subvalvular = 230). At follow‐up (range 30–47 months), a Ring + Subvalvular repair was associated with a lower mortality (RR = 0.59, 95%confidence interval [CI] 0.37–0.94, p = 0.03), greater freedom from moderate or greater MR (RR = 0.44, 95%CI 0.27–0.72, p = 0.001), and improved left ventricular end‐diastolic diameter (MD = −3.49 mm, 95%CI −5.45 to −1.53, p = 0.0005) and New York Heart Association functional class (MD = −0.25, 95%CI −0.42 to −0.08, p = 0.004). A trend toward a reduced risk of reoperation for recurrent MR was noted with a combined Ring + Subvalvular repair (RR = 0.28, 95%CI 0.06–1.22, p = 0.09). Finally, a Ring + Subvalvular repair did not impact operative mortality or follow‐up left ventricular ejection fraction. Conclusion A combined Ring + Subvalvular repair for moderate‐to‐severe functional MR can be safely performed, and may improve mid‐term outcomes, as compared with Ring alone. doi: 10.1111/jocs.12662 (J Card Surg 2016;31:31–37)