Mitral Regurgitation Grading in the Operating Room: A Systematic Review and Meta-analysis Comparing Preoperative and Intraoperative Assessments During Cardiac Surgery

摘要

Objective To assess differences in mitral regurgitation (MR) grade between the preoperative and the intraoperative evaluations. Design Systematic review and meta-analysis of 6 observational studies found from MEDLINE and EMBASE. Setting Cardiac surgery. Participants One hundred thirty-seven patients. Intervention Comparison between the preoperative MR assessment and the intraoperative evaluation conducted under general anesthesia (GA), with or without “hemodynamic matching” (HM) (artificial increase of afterload). Measurements and Main Results The primary outcome was the difference between the preoperative and intraoperative MR grade under “GA-only” or “after-HM.” Secondary analyses addressed differences according to effective regurgitant orifice area (EROA), regurgitant volume (RVol), color-jet area, and vena contracta width. Risk of MR underestimation was found under “GA-only” (SMD: 0.55; 95% confidence interval [CI], 0.31–0.79, p Conclusions Intraoperative assessment under “GA-only” significantly underestimated MR. A more accurate intraoperative evaluation can be obtained with afterload manipulation, although HM strategy carries high risk of clinically significant overestimation.