讀書報告 ▏對于缺血性二尖瓣反流的患者冠狀動脈搭橋術(shù)與冠狀動脈搭橋聯(lián)合二尖瓣修復(fù)術(shù)的對比研究：一項...

漸近故鄉(xiāng)時 2017-04-19

展開全文

文獻(xiàn)：Coronary ArteryBypass Grafting Versus Combined Coronary Artery Bypass Grafting and MitralValve Repair in Treating Ischaemic Mitral Regurgitation: A Meta-analysis

Heart,Lung and Circulation (2014) 23, 905–912

LiangYin, PhD, Zhinong Wang, MD, Hua Shen, PhD, Jie Min, PhD, Xinyu Ling, PhD, WangXi, PhD

報告人：蒲利紅

Objectives

Afocussed clinical question was designed and a meta-analysis of publishedstudies was performed to identify the impact of mitral valve repair (MVR) inpatients with IMR undergoing CABG versus those undergoing CABG alone.

Background

Ischaemicmitral regurgitation (IMR) is commonly manifested after coronary arterydisease, but it is still controversial as to whether coronary artery bypassgrafting (CABG) alone improves postoperative outcome.

Methods

Using theMedline database, the Cochrane clinical trials database and online clinicaltrial databases, we reviewed all RCTs and observational studies examining theimpact of MVR and CABG in treating patients with IMR. We searched forliterature published before September 2013 and earlier.

Results

This analysisidentified five studies which examined the impact of CABG alone versus combinedCABG and MVR in treating patients with IMR, involving 1038 patients, with 423patients undergoing CABG alone and 615 were performed combined CABG and MVRprocedures. There was significant improvement in postoperative mitralregurgitation (MR) grade in combined group, comparing with CABG alone group(WMD:1.34, 95% CI: 0.47 to 2.21, p = 0.003), but no significant differenceswere noted between the CABG plus MVR group and CABG alone group in terms ofin-hospital mortality (OR: 0.84, 95% CI: 0.44 to 1.61, p = 0.60), MR gradeimprovement rate (OR: 0.19, 95% CI: 0.02 to 1.66, p = 0.13), postoperative meanNYHA functional class (WMD: 0.33, 95% CI: -0.29 to 0.94, p = 0.30) andfive-year survival (OR: 0.77, 95% CI: 0.34 to 1.73, p = 0.53).

Conclusions

Compared withCABG alone, patients who underwent combined CABG and MVR procedures showed agreater improvement in postoperative MR grade, but in terms of in-hospitalmortality, MR grade improvement rate, postoperative mean NYHA functional classand five-year survival, adding MVR to CABG surgery lacks evidence to show itssuperiority.

題目

對于缺血性二尖瓣反流的患者冠狀動脈搭橋術(shù)與冠狀動脈搭橋聯(lián)合二尖瓣修復(fù)術(shù)的對比研究：一項Meta分析。

目的

關(guān)注于一個臨床問題，用對于現(xiàn)有研究的Meta分析來證明CABG+二尖瓣修復(fù)術(shù)與單純的CABG相比對缺血性二尖瓣反流患者預(yù)后的影響。

背景

缺血性二尖瓣反流是冠脈疾病中公認(rèn)的常見并發(fā)癥之一，但是對于單純的冠脈搭橋術(shù)是否提高患者的預(yù)后仍然是有爭議的。

方法

利用Meline數(shù)據(jù)庫、Cochrane臨床試驗數(shù)據(jù)庫和在線臨床試驗數(shù)據(jù)庫，我們回顧了所有的CABG和MVR術(shù)對患者預(yù)后影響的隨機(jī)對照試驗研究和觀察性研究，我們查找了2013年9月以及之前發(fā)表的文獻(xiàn)。

結(jié)果

這項Mate分析整合了之前的5項研究，包含了1038例患者，其中423例進(jìn)行了單純的CABG術(shù)，其他615例進(jìn)行了CABG+MVR術(shù)，結(jié)果發(fā)現(xiàn)CABG+MVR術(shù)比單純CABG術(shù)對顯著減少患者術(shù)后二尖瓣反流程度，但是兩組的在院死亡率、二尖瓣反流程度改善率、術(shù)后NYHA心功能分級和5年生存率方面無明顯差異。