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Author Mihos, Christos G. ♦ Larrauri-Reyes, Maiteder ♦ Santana, Orlando
Source World Health Organization (WHO)-Global Index Medicus
Content type Text
Publisher Wiley
File Format HTM / HTML
Language English
Difficulty Level Medium
Subject Domain (in DDC) Natural sciences & mathematics ♦ Life sciences; biology ♦ Physiology & related subjects ♦ Natural history of organisms ♦ Technology ♦ Medicine & health ♦ Human anatomy, cytology, histology ♦ Human physiology ♦ Diseases ♦ Surgery & related medical specialties ♦ Manufacture for specific uses ♦ Precision instruments & other devices
Subject Domain (in MeSH) Cardiovascular System ♦ Anatomy ♦ Eukaryota ♦ Organisms ♦ Cardiovascular Diseases ♦ Pathological Conditions, Signs and Symptoms ♦ Diseases ♦ Diagnosis ♦ Surgical Procedures, Operative ♦ Investigative Techniques ♦ Analytical, Diagnostic and Therapeutic Techniques and Equipment ♦ Circulatory and Respiratory Physiological Phenomena ♦ Biological Sciences ♦ Persons ♦ Persons
Subject Keyword Discipline Cardiology ♦ Discipline Surgery ♦ Mitral Valve Annuloplasty ♦ Methods ♦ Mitral Valve Insufficiency ♦ Surgery ♦ Mitral Valve ♦ Aged ♦ Echocardiography ♦ Female ♦ Follow-up Studies ♦ Humans ♦ Male ♦ Middle Aged ♦ Severity Of Illness Index ♦ Stroke Volume ♦ Treatment Outcome ♦ Ventricular Function, Left ♦ Ventricular Remodeling ♦ Journal Article ♦ Meta-analysis
Abstract BACKGROUND: A ring annuloplasty (Ring) for moderate-to-severe functional mitral regurgitation (MR) is associated with suboptimal outcomes, and adjunctive subvalvular repair techniques (Ring + Subvalvular) have been advocated to improve repair durability. However, the outcomes of this strategy are not clearly defined. METHODS: A systematic review was performed to identify studies that compared a Ring versus Ring + Subvalvular repair for the treatment of moderate-to-severe functional MR. A meta-analysis was conducted on clinical outcomes and echocardiographic measures of follow-up MR and left ventricular reverse remodeling. Risk ratio (RR) and mean difference (MD) were calculated by the Mantel-Haenszel and Inverse Variance methods under a fixed or random effects model, as appropriate. RESULTS: Seven non-randomized studies were identified, with a total of 531 patients (Ring = 301, Ring + Subvalvular = 230). At follow-up (range 30-47 months), a Ring + Subvalvular repair was associated with a lower mortality (RR = 0.59, 95%confidence interval [CI] 0.37-0.94, p = 0.03), greater freedom from moderate or greater MR (RR = 0.44, 95%CI 0.27-0.72, p = 0.001), and improved left ventricular end-diastolic diameter (MD = -3.49 mm, 95%CI -5.45 to -1.53, p = 0.0005) and New York Heart Association functional class (MD = -0.25, 95%CI -0.42 to -0.08, p = 0.004). A trend toward a reduced risk of reoperation for recurrent MR was noted with a combined Ring + Subvalvular repair (RR = 0.28, 95%CI 0.06-1.22, p = 0.09). Finally, a Ring + Subvalvular repair did not impact operative mortality or follow-up left ventricular ejection fraction. CONCLUSION: A combined Ring + Subvalvular repair for moderate-to-severe functional MR can be safely performed, and may improve mid-term outcomes, as compared with Ring alone.
Description Author Affiliation: Mihos CG ( Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.); Larrauri-Reyes M ( Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Florida.); Santana O ( Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Florida.)
ISSN 08860440
Educational Role Student ♦ Teacher
Age Range above 22 year
Educational Use Reading ♦ Research ♦ Self Learning
Interactivity Type Expositive
Education Level UG and PG
Learning Resource Type Article
Publisher Date 2016-01-01
Publisher Place United States
e-ISSN 15408191
Journal Journal of Cardiac Surgery
Volume Number 31
Issue Number 1


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Source: WHO-Global Index Medicus