Key result
Percutaneous mitral valve repair using MitraClip significantly reduced all-cause mortality at 12 months compared to medical therapy (OR 0.41; 95% CI 0.24-0.69; p=0.0009).
Why the study?
It was unknown whether percutaneous mitral valve repair using MitraClip was more effective than surgery or medical therapy for long-term morbidity and mortality in secondary mitral regurgitation.
Does percutaneous mitral valve repair (PMVr) using MitraClip improve long-term morbidity and mortality in adult patients with functional or secondary mitral valve regurgitation compared to surgery or medical therapy?
Meta-Analysis (n=2,593)
Does percutaneous mitral valve repair (PMVr) using MitraClip improve long-term morbidity and mortality in adult patients with functional or secondary mitral valve regurgitation compared to surgery or medical therapy?
Odds Ratio: 0.41 (95% CI 0.24–0.69)
p-value: p=0.0009
PMVr using MitraClip significantly reduces mortality compared to medical therapy in secondary mitral regurgitation, but has inferior repair durability compared to surgery despite similar mortality outcomes.
Supports PMVr over medical therapy for mortality reduction in secondary MR; confirms RCT benefits while highlighting inferior durability versus surgery.
This systematic review and meta-analysis aimed to investigate whether percutaneous mitral valve repair (PMVr) using MitraClip was more effective than surgery or medical therapy for long-term morbidity and mortality. We searched MEDLINE, EMBASE, and CENTRAL (Cochrane Library) databases to identify relevant studies that recruited adult patients with functional or secondary mitral valve regurgitation who underwent PMVr with MitraClip implantation using appropriate search terms and Boolean operators. The odds ratios (ORs) were pooled using the random-effects model. A total of 14 studies recruiting 2,593 patients were included. Within 12 months of follow-up, patients who underwent PMVr did not maintain mitral valve regurgitation grade 2+ (OR 0.22, 95% confidence interval [CI] 0.12 to 0.41, p <0.0001, I2 = 0.0%, p = 0.52) or symptom-free heart failure (OR 0.47, 95% CI 0.29 to 0.77, p = 0.0028, I2 = 0.0%, p = 0.66) compared with their surgical counterparts. Patients were more likely to be rehospitalized for heart failure (OR 2.79, 95% CI 1.54 to 5.05, p = 0.0007, I2 = 0.0%, p = 0.51). However, there was no difference between the groups in terms of all-cause or cardiovascular mortality. Whereas, in comparison with medical therapy, PMVr significantly reduced all-cause mortality at 12 and ≥24 months of follow-up (OR 0.41, 95% CI 0.24, 0.69, p = 0.0009, I2 = 32%, p = 0.23 and OR 0.55, 95% CI 0.40, 0.75, p = 0.0002, I2 = 0.0%, p = 0.45, respectively). In conclusion, there was no difference in all-cause death at 12 or 24 months of follow-up between PMVr and the surgical approach, but the durability of valvular repair was inferior to PMVr. In comparison with medical therapy, there was a significant reduction in mortality with PMVr. This systematic review and meta-analysis aimed to investigate whether percutaneous mitral valve repair (PMVr) using MitraClip was more effective than surgery or medical therapy for long-term morbidity and mortality. We searched MEDLINE, EMBASE, and CENTRAL (Cochrane Library) databases to identify relevant studies that recruited adult patients with functional or secondary mitral valve regurgitation who underwent PMVr with MitraClip implantation using appropriate search terms and Boolean operators. The odds ratios (ORs) were pooled using the random-effects model. A total of 14 studies recruiting 2,593 patients were included. Within 12 months of follow-up, patients who underwent PMVr did not maintain mitral valve regurgitation grade 2+ (OR 0.22, 95% confidence interval [CI] 0.12 to 0.41, p <0.0001, I2 = 0.0%, p = 0.52) or symptom-free heart failure (OR 0.47, 95% CI 0.29 to 0.77, p = 0.0028, I2 = 0.0%, p = 0.66) compared with their surgical counterparts. Patients were more likely to be rehospitalized for heart failure (OR 2.79, 95% CI 1.54 to 5.05, p = 0.0007, I2 = 0.0%, p = 0.51). However, there was no difference between the groups in terms of all-cause or cardiovascular mortality. Whereas, in comparison with medical therapy, PMVr significantly reduced all-cause mortality at 12 and ≥24 months of follow-up (OR 0.41, 95% CI 0.24, 0.69, p = 0.0009, I2 = 32%, p = 0.23 and OR 0.55, 95% CI 0.40, 0.75, p = 0.0002, I2 = 0.0%, p = 0.45, respectively). In conclusion, there was no difference in all-cause death at 12 or 24 months of follow-up between PMVr and the surgical approach, but the durability of valvular repair was inferior to PMVr. In comparison with medical therapy, there was a significant reduction in mortality with PMVr. The prognosis of secondary mitral valve regurgitation (MR) remains unfavorable because of the detrimental interplay of ventricular remodeling and intrinsic myocardial disease.1Kaddoura R Al-Hijji M Transcatheter mitral valve repair in acute and critical cardiac conditions.Heart Views. 2023; 24: 29-40Crossref Google Scholar,2Petrus AHJ Klautz RJM De Bonis M Langer F Schäfers HJ Wakasa S Vahanian A Obadia JF Assi R Acker M Siepe M Braun J The optimal treatment strategy for secondary mitral regurgitation: a subject of ongoing debate.Eur J Cardiothorac Surg. 2019; 56: 631-642Crossref PubMed Scopus (7) Google Scholar Percutaneous mitral valve repair (PMVr) using MitraClip device is a less invasive approach than surgical edge-to-edge repair, which uses the same principle of valve leaflets approximation. It was developed to address the demand for patients who are at high risk or not eligible for surgery.2Petrus AHJ Klautz RJM De Bonis M Langer F Schäfers HJ Wakasa S Vahanian A Obadia JF Assi R Acker M Siepe M Braun J The optimal treatment strategy for secondary mitral regurgitation: a subject of ongoing debate.Eur J Cardiothorac Surg. 2019; 56: 631-642Crossref PubMed Scopus (7) Google Scholar The EVEREST (Endovascular Valve Edge‐to‐Edge Repair Study) II trial is the only randomized trial to date that compared PMVr with MitraClip to the conventional surgery, primarily in patients with degenerative MR.3Feldman T Foster E Glower DD Kar S Rinaldi MJ Fail PS Smalling RW Siegel R Rose GA Engeron E Loghin C Trento A Skipper ER Fudge T Letsou GV Massaro JM Mauri L EVEREST II InvestigatorsPercutaneous repair or surgery for mitral regurgitation [published correction appears in N Engl J Med 2011;365:189].N Engl J Med. 2011; 364: 1395-1406Crossref PubMed Scopus (1595) Google Scholar,4Feldman T Kar S Elmariah S Smart SC Trento A Siegel RJ Apruzzese P Fail P Rinaldi MJ Smalling RW Hermiller JB Heimansohn D Gray WA Grayburn PA Mack MJ Lim DS Acker Foster E A Glower DD Mauri L EVEREST II comparison of percutaneous repair and surgery for mitral regurgitation: of EVEREST PubMed Scopus Google Scholar the JF D N T C F D M P F C E L N N M E F D C P Vahanian A N InvestigatorsPercutaneous repair or medical treatment for secondary mitral Engl J Med. 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Kaddoura et al. (2023) conducted a meta-analysis in functional or secondary mitral valve regurgitation (n=2,593). Percutaneous mitral valve repair (PMVr) using MitraClip vs. Surgery or medical therapy was evaluated on All-cause mortality at 12 months (vs medical therapy) (OR 0.41, 95% CI 0.24-0.69, p=0.0009). Percutaneous mitral valve repair using MitraClip significantly reduced all-cause mortality at 12 months compared to medical therapy (OR 0.41; 95% CI 0.24-0.69; p=0.0009).
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