Treatment options for ischemic mitral regurgitation: a meta-analysis

Abstract Background Treatment of ischemic mitral regurgitation (IMR) is in evolution as percutaneous procedures and complex surgical repair have been recently investigated in randomized clinical trials and matched studies. This study aims to review and compare the current treatment options for IMR. Methods A comprehensive literature search was conducted using electronic databases. The primary outcome was all-cause long-term mortality. The secondary outcomes were perioperative mortality, unplanned rehospitalization, reoperation, and composite endpoints as defined in the original articles. Results A total of 12 articles met the inclusion criteria and were included in the final meta-analysis. The MitraClip procedure did not confer a significant benefit in mortality and repeated hospitalization compared to medical therapy alone. In patients with moderate IMR, the adjunct of mitral procedure over CABG is not associated with clinical improvements. When evaluating mitral valve (MV) replacement vs repair, hospital mortality was higher among patients undergoing replacement (OR 1.91, P=0.009), but both reoperation and readmission rates were lower (OR 0.60, P=0.05 and OR 0.45, P Conclusions MitraClip procedure is not associated with improved outcomes compared with medical therapy. MV replacement is associated with increased early mortality but reduced reoperation rate and readmission rate compared to MV repair using annuloplasty in moderate-to-severe IMR. Despite no significant benefit in isolated outcomes comparing annular and adjunct subvalvular procedures, the adjunct of subvalvular procedures reduces the risk of major postoperative adverse events.