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文献：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 报告人：蒲利红 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. 题目 对于缺血性二尖瓣反流的患者冠状动脉搭桥术与冠状动脉搭桥联合二尖瓣修复术的对比研究：一项Meta分析。 目的 关注于一个临床问题，用对于现有研究的Meta分析来证明CABG+二尖瓣修复术与单纯的CABG相比对缺血性二尖瓣反流患者预后的影响。 背景 缺血性二尖瓣反流是冠脉疾病中公认的常见并发症之一，但是对于单纯的冠脉搭桥术是否提高患者的预后仍然是有争议的。 方法 利用Meline数据库、Cochrane临床试验数据库和在线临床试验数据库，我们回顾了所有的CABG和MVR术对患者预后影响的随机对照试验研究和观察性研究，我们查找了2013年9月以及之前发表的文献。 结果 这项Mate分析整合了之前的5项研究，包含了1038例患者，其中423例进行了单纯的CABG术，其他615例进行了CABG+MVR术，结果发现CABG+MVR术比单纯CABG术对显著减少患者术后二尖瓣反流程度，但是两组的在院死亡率、二尖瓣反流程度改善率、术后NYHA心功能分级和5年生存率方面无明显差异。 结论 CABG+MVR术比单纯的CABG术减少患者术后二尖瓣反流程度，但是在院死亡率、二尖瓣反流程度改进率、术后NYHA心功能分级和5年生存率方面缺少证据证明其优越性。 |
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