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

Abstract

Abstract This study aims to determine whether subvalvular papillary muscle (PMs) repair (SPM-r) plus restrictive mitral valve (MV) annuloplasty (RMA) is the most effective treatment for patients with secondary ischemic mitral regurgitation. 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. CABG without mitral valve surgery had a late mortality incidence of 3.7%. RMA demonstrated a rate of 6.5%, while RMA + CABG resulted in a rate of 4.1%. SPM-r plus RMA ± CABG and MV-rpl + CABG had rates of 4.4% and 5.1%. SUCRA analysis showed that coronary artery bypass grafting (CABG) was the most effective treatment for reducing late mortality (70.0%). This was followed by SPM-r plus RMA with or without CABG (62.4%). The top strategy for decreasing early death, reoperation, and readmission to the hospital for heart failure is SPM-r plus RMA with or without CABG, based on SUCRA probabilities (84.6%, 85.54%, and 86.3%, respectively). SPM-s plus RMA ± 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.