BACKGROUND

Despite revascularization and optimal medial therapy (OMT) residual ischemic mitral regurgitation (IMR) continues in a self-aggravating vicious cycle to affect prognosis and survival adversely. Mitral valve surgery in combination with coronary artery bypass graft remains a subject of debate due to the absence of a net overall benefit. Mitral valve transcatheter edge-to-edge repair (M-TEER) has been gaining grounds as a viable option from observational studies, but results from randomized controlled trials (RCTs) have yielded mixed results. Thus, this study was conducted to determine whether the current collective data support the efficacy of M-TEER with OMT versus OMT alone in patients with clinically significant IMR.

METHODS

A literature search from PubMed/MEDLINE, Cochrane Review Central, Clinical Trials Registry, ResearchGate, Mendeley, and Google Scholar for relevant RCTs and observational studies was conducted and reviewed independently by three reviewers. Published and unpublished studies indexed from inception until 2023 were included. The pooled estimates for the primary outcome of all-cause mortality and secondary outcomes of cardiac mortality and heart failure hospitalizations were measured using R Studio statistical software (R Foundation forStatistical Computing, Vienna, Austria).

RESULTS

Seven eligible studies (five observational and two RCTs) allocated 1610 IMR patients to M-TEER + OMT (n = 942) or OMT alone (n = 668). The effect estimate using random-effects model demonstrated M-TEER with OMT to significantly reduce 1-year (odds ratio [OR], 0.67; 95% confidence interval [CI], 0.52–0.86; P = 0.002) and 2-year (OR, 0.50; 95% CI, 0.38–0.67; P < 0.00001) all-cause mortality. Cardiac mortality (OR, 0.58; 95% CI, 0.27–1.23; P = 0.15) and heart failure hospitalization (OR, 0.45; 95% CI, 0.18–1.13; P = 0.09) did not reach statistical significance between the treatment arms.

CONCLUSION

In patients with IMR, M-TEER on top of OMT was able to afford a 2-year allcause mortality advantage.

BACKGROUND

Postoperative atrial fibrillation (POAF) is the most common arrythmia to occur after cardiovascular surgery. Inflammation being pivotal in POAF perpetuation has been utilized as a therapeutic target. Owing to their anti-inflammatory and anti-oxidant effects, beta-blockers (BB) and N-acetylcysteine (NAC) became research interests in the pursuit for an effective POAF prevention strategy.

OBJECTIVE

To determine the efficacy of NAC plus BB versus BB alone in preventing POAF in cardiac surgery patients.

METHODOLOGY

A literature search using the following search engines: PubMed/Medline, Cochrane Review Central, Clinical Trials Registry, ResearchGate, Mendeley and Google Scholar for relevant randomized trials were conducted. Published and unpublished studies indexed from inception until 2023 were included. Three independent reviewers evaluated the randomized clinical trials (RCTs) for eligibility. The pooled estimates for POAF prevention as primary outcome and MACE, mortality, myocardial infarction, stroke, ICU LOS and hospital LOS as secondary outcomes were measured using the RStudio statistical software.

RESULTS

Seven eligible RCTs allocated 1069 cardiac surgery patients to NAC + BB (n=539) and BB alone (N = 530) treatment arms. The effect estimate using random effect model disclosed significantly reduced POAF events (RR 0.62, 95% CI [0.44, 0.86], p = 0.005) in those on NAC + BB. While no statistical difference between the study arms were demonstrated in reducing mortality (RR 0.63, 95% CI [0.23, 1.73], p = 0.37); myocardial infarction (RR 1.02, 95% CI [0.49, 2.13], p = 0.96); stroke (RR 0.95, 95% CI [0.24, 3.68], p = 0.94); ICU LOS (std. mean difference 0.14, 95% CI [-0.43, 0.70], p = 0.41), and hospital LOS (std. mean difference 0.08, 95% CI [-0.06, 0.21], p = 0.19).

CONCLUSION

Among cardiac surgery patients, the use of NAC in combination with BB compared with BB alone significantly reduced POAF.

Acetylcysteine ; Arrhythmias, Cardiac ; Atrial Fibrillation ; Myocardial Infarction ; Omega-chloroacetophenone