Key result
Transcatheter MitraClip was associated with a reduced risk of all-cause mortality (RR 0.87) compared to non-MitraClip treatments in patients with heart failure complicated by ventricular functional mitral regurgitation.
Why the study?
The impact of different mitral valve treatments on cardiac remodeling, function, and clinical outcomes in patients with heart failure and ventricular functional mitral regurgitation remained unclear.
Do different treatments (MitraClip, surgical MV repair, surgical MV replacement, medical therapy) improve LVEF, LV remodeling, and clinical outcomes in patients with heart failure complicated by ventricular functional mitral regurgitation?
Meta-Analysis (n=2,533)
Do different treatments (MitraClip, surgical MV repair, surgical MV replacement, medical therapy) improve LVEF, LV remodeling, and clinical outcomes in patients with heart failure complicated by ventricular functional mitral regurgitation?
Transcatheter MitraClip is associated with improved long-term survival and LV remodeling in patients with HF and functional mitral regurgitation, while surgical MV repair improves LVEF compared to replacement.
Answers are grounded in this paper and cite their sources.
Supports MitraClip consideration for survival benefit in HF with functional MR; extends meta-analytic associations but requires RCT confirmation.
Background: Ventricular functional mitral regurgitation (FMR) is a common morbidity in patients with heart failure (HF). In addition to guideline-directed medical therapy, mitral valve (MV) repair or replacement has become an option for such patients. However, the impact of different treatments on cardiac remodeling, function, and clinical outcomes remains unclear. Methods: We systematically searched PubMed, EMBASE, Medline, Clinical Trials.gov, and the Cochrane Central Register of Controlled Trials with search terms related to mitral regurgitation, mitral valve repair, surgical mitral valve replacement, mitral annuloplasty device, and MitraClip. The outcomes were left ventricular ejection fraction (LVEF), left ventricular (LV) remodeling, all-cause mortality, cardiovascular death, and HF hospitalization. Sensitivity analysis was performed by removing high-bias risk studies. The analysis was done by Review Manager 5.4 Analyzer and MedCalc Statistical Software version 19.2.6. Results: This meta-analysis included 10 studies with a total of 2533 patients (567 with transcatheter MitraClip, 823 with surgical MV repair, 651 with surgical MV replacement, and 492 with medical therapy). Our meta-analysis revealed that surgical MV repair had significant improvement in LVEF compared to the surgical MV replacement (mean differences (MD) 2.32, [95% CI 0.39, 4.25]), while transcatheter MitraClip treatment was associated with LVEF reduction (MD -4.82, [95% CI -7.29, -2.34]). In terms of LV remodeling, transcatheter MitraClip treatment was associated with improvement in left ventricular end-diastolic volume (MD -10.36, [95% CI -18.74, -1.99]). Furthermore, compared to surgical MV replacement, surgical MV repair was not associated with a reduction of all-cause mortality (risk ratio (RR) 0.83, [95% CI 0.61, 1.13]) and cardiovascular death (RR 0.95, [95% CI 0.56, 1.62]), while transcatheter MitraClip was associated with reduced risk of all-cause mortality (RR 0.87, [95% CI 0.78, 0.98]). Conclusions: Surgical MV repair was associated with significant improvement in LVEF but had no significant effect on all-cause mortality compared to surgical MV replacement. Transcatheter MitraClip was associated with better long-term survival than the non-MitraClip group, thus, transcatheter MitraClip could be considered an alternative treatment in patients with HF-complicated ventricular FMR.
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Sasmita et al. (2024) conducted a meta-analysis in Heart failure complicated by ventricular functional mitral regurgitation (n=2,533). Transcatheter MitraClip and Surgical MV repair vs. Surgical MV replacement and Medical therapy was evaluated on All-cause mortality (Transcatheter MitraClip vs. Non-MitraClip) (RR 0.87, 95% CI 0.78, 0.98). Transcatheter MitraClip was associated with a reduced risk of all-cause mortality (RR 0.87) compared to non-MitraClip treatments in patients with heart failure complicated by ventricular functional mitral regurgitation.
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