Key result
Transcatheter mitral valve repair showed no significant difference in stroke incidence compared with surgical mitral valve repair (OR 0.49; 95% CI 0.17-1.42; p=0.19) or optimal medical treatment.
Why the study?
To assess stroke rates following transcatheter mitral valve repair with the MitraClip compared with surgical mitral valve repair and optimal medical treatment.
Does transcatheter mitral valve repair (TMVR) with MitraClip reduce stroke incidence compared to surgical mitral valve repair or optimal medical treatment in patients with severe mitral regurgitation?
Meta-Analysis (n=1,881)
Does transcatheter mitral valve repair (TMVR) with MitraClip reduce stroke incidence compared to surgical mitral valve repair or optimal medical treatment in patients with severe mitral regurgitation?
Odds Ratio: 0.49 (95% CI 0.17–1.42)
p-value: p=0.19
TMVR with MitraClip has a similar stroke risk compared to surgical mitral valve repair and optimal medical therapy, with a trend toward lower risk versus surgery.
Reassures on TMVR stroke safety versus SMVR or OMT; reinforces meta-analytic evidence for procedural choice in severe MR.
AIMS: The aim of this study was to assess the stroke rate after transcatheter mitral valve repair (TMVR) with the MitraClip, comparing it with surgical mitral valve repair (SMVR) and optimal medical treatment (OMT). METHODS AND RESULTS: In December 2018, we systematically searched PubMed, Embase and Cochrane Controlled Register of Trials for studies comparing TMVR with SMVR and/or OMT for the treatment of severe mitral regurgitation. Random-effects and cumulative meta-analysis was performed. Ten studies were included (seven of TMVR versus SMVR and three of TMVR versus OMT), providing a total of 1,881 patients and 61 pooled strokes (16 in TMVR versus SMVR and 45 in TMVR versus OMT). There was no difference in stroke incidence between TMVR and SMVR (pooled OR 0.49 [0.17, 1.42], p=0.19). However, there was a trend towards a lower stroke risk in TMVR. For TMVR versus OMT, no difference in stroke rate was identified (pooled OR 1.09 [0.60, 1.97], p=0.79). Post-procedure de novo atrial fibrillation was more frequent in SMVR when compared with TMVR. CONCLUSIONS: Despite both a low number of pooled stroke events and the failure to reach the pre-specified statistical significance, there was a trend for a lower post-procedure stroke rate in TMVR when compared with SMVR and a similar one between TMVR and OMT alone.
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Silva et al. (2020) conducted a meta-analysis in severe mitral regurgitation (n=1,881). Transcatheter mitral valve repair (TMVR) with MitraClip vs. Surgical mitral valve repair (SMVR) and optimal medical treatment (OMT) was evaluated on Stroke incidence (OR 0.49, 95% CI 0.17-1.42, p=0.19). Transcatheter mitral valve repair showed no significant difference in stroke incidence compared with surgical mitral valve repair (OR 0.49; 95% CI 0.17-1.42; p=0.19) or optimal medical treatment.
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