SciELO - Scientific Electronic Library Online

 
vol.28 issue2Cardiodesfibriladores implantables: Diecinueve años de experiencia en un centro de nuestro paísHipertensión pulmonar en la EPOC: puesta al día author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

Related links

Share


Revista Uruguaya de Cardiología

On-line version ISSN 1688-0420

Abstract

DAYAN, Víctor; SOCA, Gerardo  and  CURA, Leandro. Metaanálisis del tratamiento quirúrgico para la insuficiencia mitral isquémica: ¿Reemplazo o sustitución?. Rev.Urug.Cardiol. [online]. 2013, vol.28, n.2, pp.151-162. ISSN 1688-0420.

Background: Ischemic Mitral Regurgitation is a frequent complication of coronary artery disease. It results in post-ischemic ventricular remodeling with secondary compromise of the valvular mechanism. As it is a consequence of a ventricular pathology its prognostic is worst than primary mitral regurgitation. Despite surgical indication is clear, it is not defined the best strategy: valvular substitution or repair. Objective: To review and meta-analyze current published evidence in reference to mitral substitution (MS) versus mitral repair (MR) in ischemic mitral regurgitation with focus on surgical mortality, survival and recurrence. Methods: using predefined keywords, Pubmed, Embase, Ovid and Google Scholar databases were reviewed looking for comparative publications between MS and MR in ischemic mitral regurgitation. Strict inclusion and exclusion criteria representing actual surgical practice were defined. Using a model of random effects, hazard-ratio (HR) combined for survival and odds-ratio (OR) combined for surgical mortality and recurrence of mitral regurgitation were calculated. Sub-group and meta-regression analysis were performed to evaluate co-variables effects on results and heterogeneity.   Results: A total of 280 publications were identified of whom 36 fulfill search criteria. Twelve out of 36 fulfill the predefined inclusion and exclusion criteria. These publications include a total of 2509 patients, in 64% of whom a MR was performed and a MS in the rest. There was less surgical mortality in patients with MR (OR 0.70; CI 95% 0.38-0.85, p 0.001). However, considering only patients operated after 1998, OR was 0.70 (CI 95% 0.44-1.12, p 0.14). Survival was similar in both groups (HR 0.86; CI 95% 0.66-1.13, p 0.28). Mitral valve regurgitation recurrence was more frequent in MR (OR 7.51; CI 95% 3.7-15.23, p 0.001) Conclusion: MR reduces surgical mortality in patients with ischemic mitral regurgitation but has a major mitral regurgitation recurrence. Both techniques have similar survival in the long term. Decision of MR or MS should be individualized considering embolic risks and presence of predictors of mitral regurgitation recurrence.

Keywords : MITRAL VALVE INSUFFICIENCY; REVIEW;     META-ANALYSIS.

        · abstract in Spanish     · text in Spanish     · Spanish ( pdf )

 

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License