二尖瓣手术联合冠状动脉搭桥治疗缺血性二尖瓣反流的Meta分析

Effect of Mitral Valve Surgery Combined with Coronary Artery Bypass Graft on Ischemic Mitral Regurgitation: A Meta-analysis

目的运用循证医学方法探讨二尖瓣手术(MVS)联合冠状动脉搭桥术(CABG)治疗中重度缺血性二尖瓣反流(IMR)的疗效。方法计算机检索OVID、MEDLINE、EMBASE、Web of Science、Cochrane Liborary等数据库中有关CABG及CABG+MVS治疗中重度IMR患者的临床研究,采用Stata 12.0软件进行Meta分析。结果共纳入9个非随机试验和1个随机对照试验,其中CABG组1 549例,CABG+MVS组1 002例。Meta分析结果显示,MVS+CABG与CABG组远期死亡率、术后远期纽约心功能分级比较,差异无统计学意义(P>0.05);MVS+CABG在改善远期二尖瓣反流分级方面优于CABG(P<0.05)。结论在治疗中重度IMR方面是否有必要联合CABG与MVS仍需要更多的临床研究证实。

Objective To investigate the effect of mitral valve surgery（ MVS） combined with coronary artery bypass graft（ CABG） on moderate,severe ischemic mitral regurgitation（ IMR） with the method of evidence-based medicine.Methods The databases including OVID,MEDLINE,EMBASE,Web of Science,Cochrane Library were retrieved for the relevant clinical trials on CABG and CABG plus MVS for the treatment of moderate,severe IMR patients. Stata 12. 0 software was applied to a Meta-analysis. Results Nine non-randomized trials and 1 randomized controlled trial were included,1 549 cases in the CABG group,1002 cases in the CABG plus MVS group. The results of Meta-analysis were as follows. There were no significant differences in the long-term mortality,long-term postoperative NYHA heart function classification between CABG plus MVS group and CABG group（ P〉0. 05）. CABG plus MVS was superior to CABG in terms of the long-term mitral regurgitation grade（ P〈0. 05）. Conclusion More clinical studies are needed to demonstrate the necessity of applying CABG combined with MVS to the treatment of moderate to severe IMR.