Key result
MitraClip demonstrated similar operative mortality compared to mitral valve surgery (3% vs 5%, OR 0.58) in patients with severe mitral regurgitation, despite higher baseline risk.
Why the study?
Mitral valve surgery is gold-standard treatment for severe symptomatic mitral regurgitation, but percutaneous MitraClip offers an alternative particularly for high-risk patients warranting a pooled comparison.
Does percutaneous MitraClip improve mortality compared to mitral valve surgery in patients with severe mitral regurgitation?
Meta-Analysis (n=1,171)
Yes
Does percutaneous MitraClip improve mortality compared to mitral valve surgery in patients with severe mitral regurgitation?
Odds Ratio: 0.58 (95% CI 0.28–1.19)
Absolute Event Rate: 3% vs 5%
p-value: p=0.14
In a meta-analysis of patients with severe mitral regurgitation, MitraClip demonstrated similar short- and long-term mortality to mitral valve surgery despite a higher baseline risk profile, though it was associated with more residual regurgitation and readmissions.
Similar mortality supports MitraClip in higher-risk patients; extends prior data to 3-year outcomes.
AIMS: Mitral valve surgery (MVS) is the gold-standard treatment for severe symptomatic mitral regurgitation. Percutaneous mitral valve interventions such as the MitraClip procedure offer another dimension to its management particularly in high-risk patients. We meta-analysed the outcomes of MitraClip and MVS. METHODS AND RESULTS: PubMed, MEDLINE, Embase, Cochrane and Scopus from 1980/01-2019/06 were searched for eligible studies. Data were extracted and pooled using random-effects models. After screening 959 studies and reviewing 21 full-text articles, nine studies totalling 640 MitraClip and 531 MVS (91% valve repair) procedures were included in the meta-analysis. MitraClip patients were older, with a higher prevalence of previous cardiac surgery, coronary disease and a higher EuroSCORE (all p<0.05) than MVS patients. Pooled operative mortality was similar for MitraClip, 3%, versus MVS, 5%, odds ratio (OR): 0.58, 95%, CI: 0.28-1.19, as well as at 1 year mortality, OR: 1.09, CI: 0.71-1.68 and 3-year mortality, OR: 1.08, CI: 0.72-0.163. MitraClip patients had higher rates of early and late significant mitral regurgitation (MR) and more cardiovascular readmissions, while MVS had higher rates of in-hospital bleeding and pacemaker implantation (all p<0.05). CONCLUSIONS: MitraClip patients had a higher baseline risk than MVS, but there were no significant differences in short- and long-term mortality. MitraClip patients had higher rates of cardiovascular admissions and significant MR post-operatively, while MVS patients had more procedural complications.
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Wang et al. (2020) conducted a meta-analysis in Severe mitral regurgitation (n=1,171). MitraClip vs. Mitral valve surgery was evaluated on Operative mortality (OR 0.58, 95% CI 0.28-1.19, p=0.14). MitraClip demonstrated similar operative mortality compared to mitral valve surgery (3% vs 5%, OR 0.58) in patients with severe mitral regurgitation, despite higher baseline risk.
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