Assessing the impact of transcatheter edge-to-edge repair on reverse remodeling in secondary mitral regurgitation: a systematic review and meta-analysis

Background/Introduction Transcatheter edge-to-edge repair (TEER) is a minimally invasive intervention to reduce secondary mitral regurgitation (SMR) in patients with heart failure. While TEER improves mitral regurgitation severity, evidence on its effectiveness in promoting reverse left ventricular remodeling remains limited. This study evaluates the impact of TEER on echocardiographic measures of reverse remodeling. Purpose To assess the effects of TEER over time and to compare the effects of TEER plus GDMT versus GDMT alone on echocardiographic parameters of left ventricular and atrial remodeling in patients with SMR. Methods A systematic search of MEDLINE, EMBASE, and CENTRAL was conducted from inception to November 16, 2023. Eligible studies included patients with SMR treated with TEER and echocardiographic follow-ups. We evaluated changes in left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left atrial volume index (LAVi), left ventricular ejection fraction (LVEF) and NTproBNP levels. Bias was assessed using ROBINS-I and ROB2 tools, and evidence certainty was evaluated using the GRADE framework. The study was registered with PROSPERO. Results Of 9,290 identified studies, 38 met the inclusion criteria. In patients receiving TEER plus GDMT, significant reductions were observed in LVEDD (-1.63 mm), LVESD (-1.20 mm), LVEDV (-14.21 ml) and LVESV (-9.24 ml). LAV (-5.70 ml) and LVEF (1,1%) did not change significantly, but there was a remarkable reduction in NTproBNP levels (1340 pg/ml). Compared to GDMT alone, TEER plus GDMT showed non-significant differences in all examined parameters, e.g. LVEDD (-1.02 mm), LVEDV (-11.98 ml), LVEF (-0.14%) and LVESV (-5.29 ml). TEER reduced grade 3 mitral regurgitation from 99% to 9%. Conclusion(s) TEER plus GDMT provides significant reductions in left ventricular size but does not demonstrate a significant advantage over GDMT alone for reverse remodeling. Future research should focus on identifying patient subgroups who may derive greater benefit from TEER.