[en] BACKGROUND: The most performed repair technique for the treatment of chronic ischemic mitral regurgitation in patients referred for bypass grafting remains restricted annuloplasty. However, it is associated with a high rate of failure, especially if severe tenting exists. OBJECTIVES: To understand if adjunctive sub-valvular mitral procedures may provide better repair performance. METHODS: A systematic literature review identified six studies of which five fulfilled the criteria for meta-analysis. Outcomes for a total of 404 patients (214 had adjunctive sub-valvular procedures and 190 restricted annuloplasty) were meta-analyzed using random effects modeling. Heterogeneity and subgroup sensitivity analysis were assessed. Primary endpoints were: late recurrence of moderate mitral regurgitation, left ventricle remodeling and coaptation depth at follow-up. Secondary endpoints were: early mortality, mid-term survival and operative outcomes. RESULTS: Sub-valvular procedure technique was associated with a significantly lower late recurrence of mitral regurgitation (Odds ratio (OR) 0.34, 95% Confidence Interval (CI) [0.18, 0.65], p=0.0009), smaller left ventricle end-systolic diameter (Weighted Mean Difference (WMD) -4.06, 95% CI [-6.10, -2.03], p=0.0001) and reduced coaptation depth (WMD -2.36, 95% CI [-5.01, -0.71], p=0.009). These findings were consistent, even in studies that included patients at high risk for repair failure (coaptation depth >10 mm and tenting area >2.5 cm2). A low degree of heterogeneity was observed. There was no difference in terms of early mortality and mid-term survival; sub-valvular technique was associated with prolonged cardiopulmonary and cross-clamp time. CONCLUSIONS: Adding sub-valvular procedures when repairing ischemic chronic mitral valve regurgitation may be associated with better durability, even in the case of the presence of predictors for late failure. PERSPECTIVE: Surgical sub-valvular adjunctive procedures have to be considered in the case of the presence of echocardiographic predictors for late failure.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Moscarelli, Marco
Athanasiou, Thanos
Speziale, Giuseppe
Punjabi, Prakash P.
Malietzis, George
Lancellotti, Patrizio ; Université de Liège > Département des sciences cliniques > Imagerie cardiaque fonctionnelle par échographie
Fattouch, Khalil
Language :
English
Title :
The value of adding sub-valvular procedures for chronic ischemic mitral regurgitation surgery: a meta-analysis.
Publication date :
2017
Journal title :
Perfusion
ISSN :
0267-6591
eISSN :
1477-111X
Publisher :
SAGE Publications, New York, United States - New York
scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.
Bibliography
Bolling SF, Deeb GM, Brunsting LA, Bach DS., Early outcome of mitral valve reconstruction in patients with end-stage cardiomyopathy. J Thorac Cardiovas Surg 1995; 109: 676-682; discussion 682-673.
Levine RA, Schwammenthal E., Ischemic mitral regurgitation on the threshold of a solution: from paradoxes to unifying concepts. Circulation 2005; 112: 745-758.
Acker MA, Parides MK, Perrault LP, et al. Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. New Engl J Med 2014; 370: 23-32.
Fattouch K, Castrovinci S, Murana G, Moscarelli M, Speziale G., Surgical management of moderate ischemic mitral valve regurgitation: where do we stand? World Journal of Cardiology 2014; 6: 1218-1222.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535.
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283: 2008-2012.
The Cochrane Collaboration. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011] 2011.
Wakasa S, Shingu Y, Ooka T, Katoh H, Tachibana T, Matsui Y., Surgical strategy for ischemic mitral regurgitation adopting subvalvular and ventricular procedures. Ann Thorac Cardiovasc Surg 2015; 21: 370-377.
Calafiore AM, Refaie R, Iaco AL, et al. Chordal cutting in ischemic mitral regurgitation: a propensity-matched study. J Thorac Cardiovasc Surg 2014; 148: 41-46.
Fattouch K, Lancellotti P, Castrovinci S, et al. Papillary muscle relocation in conjunction with valve annuloplasty improve repair results in severe ischemic mitral regurgitation. J Thorac Cardiovasc Surg 2012; 143: 1352-1355.
Langer F, Kunihara T, Hell K, et al. Ring+string: successful repair technique for ischemic mitral regurgitation with severe leaflet tethering. Circulation 2009; 120: S85-91.
Borger MA, Murphy PM, Alam A, et al. Initial results of the chordal-cutting operation for ischemic mitral regurgitation. J Thorac Cardiovasc Surg 2007; 133: 1483-1492.
Manabe S, Shimokawa T, Fukui T, Tabata M, Takanashi S., Impact of papillary muscle approximation on mitral valve configuration in the surgical correction of ischemic mitral regurgitation. Thorac Cardiov Surg 2012; 60: 269-274.
Smith PK, Puskas JD, Ascheim DD, et al. Surgical treatment of moderate ischemic mitral regurgitation. New Engl J Med 2014; 371: 2178-2188.
Bertrand PB, Gutermann H, Smeets CJ, et al. Functional impact of transmitral gradients at rest and during exercise after restrictive annuloplasty for ischemic mitral regurgitation. J Thorac Cardiovasc Surg 2014; 148: 183-187.
Similar publications
Sorry the service is unavailable at the moment. Please try again later.
This website uses cookies to improve user experience. Read more
Save & Close
Accept all
Decline all
Show detailsHide details
Cookie declaration
About cookies
Strictly necessary
Performance
Strictly necessary cookies allow core website functionality such as user login and account management. The website cannot be used properly without strictly necessary cookies.
This cookie is used by Cookie-Script.com service to remember visitor cookie consent preferences. It is necessary for Cookie-Script.com cookie banner to work properly.
Performance cookies are used to see how visitors use the website, eg. analytics cookies. Those cookies cannot be used to directly identify a certain visitor.
Used to store the attribution information, the referrer initially used to visit the website
Cookies are small text files that are placed on your computer by websites that you visit. Websites use cookies to help users navigate efficiently and perform certain functions. Cookies that are required for the website to operate properly are allowed to be set without your permission. All other cookies need to be approved before they can be set in the browser.
You can change your consent to cookie usage at any time on our Privacy Policy page.