Clinical efficacy of different surgical approaches for moderate-to-severe ischemic mitral regurgitation: A systematic review and network meta-analysis
- VernacularTitle:不同外科术式治疗中-重度缺血性二尖瓣反流疗效的系统评价与网状Meta分析
- Author:
Zhili WEI
1
;
Shuai DONG
2
;
Xuhua LI
1
;
Yang CHEN
1
;
Shidong LIU
2
;
Bing SONG
2
Author Information
1. The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, P. R. China
2. Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, P. R. China
- Publication Type:Journal Article
- Keywords:
Coronary artery bypass grafting;
mitral valve repair;
mitral valve replacement;
transcatheter mitral valve edge-to-edge repair;
ischemic mitral regurgitation;
systematic review/network meta-analysis
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2026;33(04):631-638
- CountryChina
- Language:Chinese
-
Abstract:
Objective To systematically evaluate the therapeutic effects of different surgical procedures for ischemic mitral regurgitation (IMR). Methods Computer searches were conducted in CNKI, Wanfang, VIP, CBM, PubMed, 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. Results A 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), P<0.01], mitral valve replacement (MVR) [OR=0.43, 95%CI (0.23, 0.79), P=0.02], CABG+MVR [OR=0.21, 95%CI (0.04, 0.95), P=0.03] and transcatheter mitral valve edge-to-edge repair (TEER) using MitraClip [OR=0.13, 95%CI (0.02, 0.87), P<0.01]. 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), P=0.02] and CABG+MVR [OR=0.48, 95%CI (0.24, 0.94), P=0.04], 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), P=0.01]; the best probability ranking results showed that CABG+MVr might be the most effective in reducing renal complications. Conclusion The 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.
