Why the study?
Some patients with acute MR or decompensated heart failure could benefit from urgent TMVr, but clinical outcomes compared with elective TMVr needed evaluation.
Does urgent TMVr compared to elective TMVr affect all-cause mortality in patients with mitral regurgitation?
Does urgent TMVr compared to elective TMVr affect all-cause mortality in patients with mitral regurgitation?
Urgent TMVr has similar procedural success and 1-year mortality compared to elective TMVr, though it is associated with higher rates of postoperative AKI and potentially higher unadjusted 30-day mortality.
Urgent TMVr warrants heightened caution given elevated short-term mortality; extends meta-analytic evidence on procedural timing in decompensated MR.
Background: Mitral regurgitation (MR) is the most common valvular disease worldwide. MR has been managed surgically, with either a mitral valve replacement or repair. Percutaneous transcatheter mitral valve repair (TMVr) with MitraClip ® insertion has gained wide popularity and success over medical and surgical therapy for MR. Some patients with acute MR or decompensated heart failure could benefit from urgent TMVr. This meta-analysis aims to compare clinical outcomes of urgent versus elective TMVr. Methods: We performed a study-level meta-analysis to compare the clinical outcomes of urgent versus elective TMVr using the MitraClip system. The primary endpoint outcome was all-cause mortality. Additional outcomes included procedural success, postoperative acute kidney injury (AKI), stroke, and length of in-hospital stay. Results: Overall, 30-day mortality was significantly higher in the urgent group (odds ratio [OR]: 2.74; 95% confidence interval [CI] [2.17, 3.48]; P < 0.00001; I ² =0%). However, subgroup analysis of matched cohorts showed no significant difference between both groups (OR: 1.80; 95% CI [0.94, 3.46]; P = 0.08; I ² =0%). One-year mortality was similar between both groups (and: 1.67; 95% CI [0.96, 2.90]; P = 0.07; I ² =0%). Procedural success was similar between both groups (89.4% vs. 89.8%; P = 0.43). Postoperative AKI was significantly higher in the urgent group (OR: 4.12; 95% CI [2.87, 5.91]; P < 0.00001; I ² =0%). Conclusion: Urgent TMVr should be indicated in select populations as it is considered therapeutic with acceptable outcomes therein.
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Al‐Tawil et al. (2024) studied this question.
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