Best treatment option for secondary mitral regurgitation surgery: a network meta-analysis of randomized and non-randomized controlled studies

Abstract

The objective of this study is to ascertain whether subvalvular papillary muscle repair in conjunction with restrictive mitral valve annuloplasty represents the most efficacious treatment for patients presenting with secondary ischemic mitral regurgitation, as compared to restrictive mitral valve annuloplasty alone and to mitral valve replacement. A network meta-analysis was conducted to investigate outcomes of randomized controlled trials, propensity-matched studies, and observational studies, comparing various treatments for secondary ischemic mitral regurgitation. The average follow-up duration for late mortality was 4.4 years. Coronary artery bypass grafting (CABG) without mitral valve surgery had a late mortality incidence of 3.7%. Restrictive mitral annuloplasty demonstrated a rate of 6.5%, while restrictive mitral annuloplasty + CABG resulted in a rate of 4.1%. Subvalvular papillary muscle repair plus restrictive mitral annuloplasty ± CABG and mitral valve replacement + CABG had rates of 4.4% and 5.1%. SUCRA analysis showed that CABG was the most effective treatment for reducing late mortality (70.0%). This was followed by subvalvular papillary muscle repair plus restrictive mitral annuloplasty with or without CABG (62.4%). The top strategy for decreasing early death, reoperation, and readmission to the hospital for heart failure is subvalvular papillary muscle repair plus restrictive mitral annuloplasty with or without CABG, based on SUCRA probabilities (84.6%, 85.54%, and 86.3%, respectively). Subvalvular papillary muscle repair plus restrictive mitral annuloplasty ± CABG has potential to reduce the risks associated with early mortality, reoperation, and re-hospitalization for heart failure. However, further research is required to substantiate these findings.

Keywords: Ischemic mitral regurgitation, restrictive mitral valve repair; Metanalysis; Mitral valve; Mitral valve replacement; Subvalvular papillary muscle replacement.

Fig. 1

Prisma flow diagram with studies selection.

Fig. 2

Network plot.

Fig. 3

League tables. (A) Pairwise comparisons for late mortality. (B) Pairwise comparisons for early mortality. (C) Pairwise comparisons for reoperation. (D) Pairwise comparisons for re-hospitalization for heart failure.

Fig. 4

SUCRA plots. (A) Cumulative ranking probabilities for late mortality. (B) Cumulative ranking probabilities for early mortality. (C) Cumulative ranking probabilities for reoperation. (D) Cumulative ranking probabilities for re-hospitalization for heart failure.