Outcome after percutaneous edge-to-edge mitral repair for functional and degenerative mitral regurgitation: A systematic review and meta-analysis

Mauro Chiarito, Matteo Pagnesi, Enrico Antonio Martino, Michele Pighi, Andrea Scotti, Giuseppe Biondi-Zoccai, Azeem Latib, Giovanni Landoni, Carlo Di Mario, Alberto Margonato, Francesco Maisano, Ted Feldman, Ottavio Alfieri, Antonio Colombo, Cosmo Godino

Research output: Contribution to journalArticlepeer-review

34 Scopus citations

Abstract

Objectives Differences in terms of safety and efficacy of percutaneous edge-to-edge mitral repair between patients with functional and degenerative mitral regurgitation (MR) are not well established. We performed a systematic review and meta-analysis to clarify these differences. Methods PubMed, EMBASE, Google scholar database and international meeting abstracts were searched for all studies about MitraClip. Studies with <25 patients or where 1-year results were not delineated between MR aetiology were excluded. This study is registered with PROSPERO. Results A total of nine studies investigating the mid-term outcome of percutaneous edge-to-edge repair in patients with functional versus degenerative MR were included in the meta-analysis (n=2615). At 1 year, there were not significant differences among groups in terms of patients with MR grade≤2 (719/1304 vs 295/504; 58% vs 54%; risk ratio (RR) 1.12; 95% CI: 0.86 to 1.47; p=0.40), while there was a significantly lower rate of mitral valve re-intervention in patients with functional MR compared with those with degenerative MR (77/1770 vs 80/818; 4% vs 10%; RR 0.60; 95% CI: 0.38 to 0.97; p=0.04). One-year mortality rate was 16% (408/2498) and similar among groups (RR 1.26; 95% CI: 0.90 to 1.77; p=0.18). Functional MR group showed significantly higher percentage of patients in New York Heart Association class III/IV (234/1480 vs 49/583; 16% vs 8%; p<0.01) and re-hospitalisation for heart failure (137/605 vs 31/220; 23% vs 14%; p=0.03). No differences were found in terms of single leaflet device attachment (25/969 vs 20/464; 3% vs 4%; p=0.81) and device embolisation (no events reported in both groups) at 1 year. Conclusions This meta-analysis suggests that percutaneous edge-to-edge repair is likely to be an efficacious and safe option in patients with both functional and degenerative MR. Large, randomised studies are ongoing and awaited to fully assess the clinical impact of the procedure in these two different MR aetiologies.

Original languageEnglish (US)
Pages (from-to)306-312
Number of pages7
JournalHeart
Volume104
Issue number4
DOIs
StatePublished - Feb 1 2018
Externally publishedYes

Keywords

  • degenerative mitral regurgitation
  • functional mitral regurgitation
  • meta-analysis
  • percutaneous edge-to-edge repair

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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