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Meta‐analysis of results of subvalvular repair for severe ischemic mitral regurgitation
Author(s) -
Meco Massimo,
Lio Antonio,
Montisci Andrea,
Panisi Paolo,
Ferrarini Matteo,
Miceli Antonio,
Glauber Mattia
Publication year - 2020
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.14490
Subject(s) - medicine , ventricle , cardiology , mitral regurgitation , odds ratio , confidence interval , concomitant , meta analysis , papillary muscle , incidence (geometry) , diastole , mitral valve , surgery , blood pressure , physics , optics
Background and Aim of the Study The aim of this meta‐analysis was to compare short‐ and long‐term outcomes of patients undergoing mitral annuloplasty (MA) with or without papillary muscle surgery (PMS) for the treatment of ischemic mitral regurgitation (IMR). Methods A systematic review and meta‐analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement were performed. Results Nine studies met the inclusion criteria. This meta‐analysis identified 478 patients: 228 patients underwent MA alone and 250 patients underwent concomitant PMS. Early mortality was similar between two groups (odds ratio [OR] 1.14, 95% confidence interval [CI], 0.51‐2.53; P = .75). PMS was associated at follow‐up with a higher freedom from cardiac‐related events ( P = .050); moreover, although both surgical techniques had a positive impact on ventricular remodeling, the PMS group showed a significant higher reduction of left ventricle end‐diastolic diameter (OR, 4.89, 95% CI, 2.77‐7.01; P < .001) and left ventricle end‐systolic diameter values (OR, 4.11, 95% CI, 1.98‐6.24; P < .001). Finally, PMS compared with MA alone was associated with a significant reduction of recurrent mitral regurgitation at follow‐up (OR, 3.25, 95% CI, 1.60‐6.59; P = .001). Conclusions This meta‐analysis demonstrated superiority in terms of ventricular remodeling of a combined approach encompassing PMS and MA over MA alone in IMR. Moreover, the association of subvalvular surgery with restrictive MA decreases the incidence of mitral regurgitation recurrence and cardiac‐related events at follow‐up.