二尖瓣修复/置换术治疗缺血性二尖瓣反流的近期及远期疗效的meta分析

Meta-analysis of Short-term and Long-term Mortality Following Mitral Valve Replacement vs Mitral Valve Repair for Ischemic Mitral Valve Regurgitation

【目的】通过meta分析,探讨缺血性二尖瓣反流瓣膜置换或修补两种处理方式(瓣膜置换或修补)的临床疗效(近期及远期生存率)有无差异。【方法】计算机检索有关中外文献,辅以手工检索,全面搜集二尖瓣修复/置换术治疗缺血性二尖瓣反流的近期及远期疗效比较的已经发表以及尚未发表的灰色文献,与缺血性二尖瓣反流外科处理相关的研究文献(瓣膜置换vs瓣膜修补),筛选后行meta分析,对比瓣膜置换vs瓣膜修补的近期与远期死亡率有无差异。【结果】共有13篇文献纳入meta分析,无中文文献入选。瓣膜置换组和瓣膜修补组患者术前一般特征无明显差异,两组间平均射血分数及严重左室功能不全患者所占比率相似,瓣膜置换组近期死亡率(院内死亡率)较瓣膜修补组高,OR=1.92(95%CI 1.37～2.21);两组远期死亡率(随访5年)无统计学显著性差异,OR=1.20(95%CI 0.95～1.5)。【结论】缺血性二尖瓣反流瓣膜修补术的近期疗效较瓣膜置换术要好,但是远期疗效(随访5年)并无显著性差异。

[ Objective ] To explore the survival difference following mitral valve replacement vs mitral valve repair in the patients with ischemic mitral valve regurgitation through meta-analysis. [ Methods] PubMed, Cochrane Library, EMbase, CNKI, CBM and other online database were searched, and some journals manually searched to collect published or grey literatures of clinical researches on all literatures about surgery treatment of ischemic mitral valve regurgitation （direct comparison of replacement vs repair）, and screened for meta-analyzing the short-term and long-term mortality following mitral valve replacement vs mitral valve repair. [ Results ] Thirteen articles in total finally entered into the meta-analysis. These studies owning the similar general patient preoperative characteristics, mean EF and proportion of severe left ventrieular dysfunction. The short-term mortality （in-hospital mortality） of the mitral valve replacement group was higher than that of the mitral valve repair group, OR = 1.92 （95% CI 1.37- 2.21）, no significant difference was found for long-term mortality between the two groups, OR = 1.20 （95% CI 0.95-1.5）. [ Conclusion ] The short-term survival was better in the mitral valve repair group for ischemic mitral valve regurgitation comparing to the mitral valve replacement group, no significant difference was found in long-term survival.