Key result
Compared to surgical repair, MitraClip in elderly patients with severe mitral regurgitation was associated with higher 1-year all-cause mortality (14% vs 9%) and lower freedom from recurrent MR.
Why the study?
Comparative studies of MitraClip versus surgical repair in typical, real-world elderly patients with severe mitral regurgitation needed to be summarized to analyze their safety and effectiveness.
Does transcatheter mitral-valve repair (MitraClip) improve mortality and recurrent MR compared to surgical mitral-valve repair in elderly patients with severe mitral regurgitation?
Meta-Analysis (n=3,355)
Does transcatheter mitral-valve repair (MitraClip) improve mortality and recurrent MR compared to surgical mitral-valve repair in elderly patients with severe mitral regurgitation?
Absolute Event Rate: 14% vs 9%
In elderly patients with severe MR, surgical repair is associated with lower long-term mortality and less recurrent MR compared to MitraClip, though MitraClip remains an option for selected high-risk patients.
MitraClip safe in high-risk elderly severe MR; leaves open its role versus surgery in gray-zone patients.
PURPOSE: To summarize comparative studies of MitraClip versus surgical repair in typical, real-world elderly patients with severe mitral regurgitation (MR) and analyze the safety and effectiveness of these therapeutic options. METHODS: PubMed, Medline, Embase, and Cochrane Controlled Register of Trials (CENTRAL) were searched for comparative studies of transcatheter mitral-valve repair (TMVR) versus surgical mitral-valve repair (SMVR) in elderly patients with severe MR from January 2000 to June 2020. Statistical pooling for incidence estimates was performed according to a random-effects model with generic inverse-variance weighting, computing risk estimates with 95% confidence intervals (CIs), using RevMan 5.3. RESULTS: A total of 14 reports comparing MitraClip with SMVR, enrolling 3355 patients with severe MR, were included in this study. Mean age, Logistic EuroSCORE, and incidence of diabetes mellitus (DM) were significantly higher in the MitraClip group, except the rate of patients with New York Heart Association (NYHA) class of >II and mean value of ejection fraction (EF). The arithmetic mean of freedom from acute mobility was similar. The 2 groups had equal all-cause mortality at 30 days, but different at 1 year (14% versus 9%) and 3 years in 7 studies (37% versus 25%). The freedom from recurrent MR ≥3+ was 88% and 97.3% at 30 days, 76.0% and 90.0% at 1 year, and 79% and 95% at 3 years in the MitraClip and surgical repair group, respectively. CONCLUSION: Although MitraClip is safe and effective in selected high-risk patients, the surgery may be the only gold standard for "gray" patients. Further studies are needed to determine whether MitraClip should be recommended.
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Yuan et al. (2021) conducted a meta-analysis in Severe mitral regurgitation (n=3,355). MitraClip (Transcatheter mitral-valve repair) vs. Surgical mitral-valve repair (SMVR) was evaluated on All-cause mortality at 1 year. Compared to surgical repair, MitraClip in elderly patients with severe mitral regurgitation was associated with higher 1-year all-cause mortality (14% vs 9%) and lower freedom from recurrent MR.
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