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Valvular heart disease
Original research
Cerebrovascular events after transcatheter mitral valve interventions: a systematic review and meta-analysis
  1. Gabriel Châteauneuf1,
  2. Tamim M Nazif2,
  3. Frédéric Beaupré1,
  4. Susheel Kodali2,
  5. Josep Rodés-Cabau1,
  6. Jean-Michel Paradis1
  1. 1 Cardiology, Quebec Heart and Lung Institute, Quebec, Quebec, Canada
  2. 2 Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
  1. Correspondence to Dr Jean-Michel Paradis, Cardiology, Quebec Heart and Lung Institute, Quebec, Canada; jean-michel.paradis{at}criucpq.ulaval.ca

Abstract

Objective Current guidelines support the use of transcatheter mitral valve interventions to treat some selected high-risk patients with significant mitral valvulopathy. As with any other interventional cardiac procedure, concerns have been raised about cerebrovascular event. The aim of this systematic review and meta-analysis was to determine the incidence of cerebrovascular events following (1) transcatheter mitral valve edge-to-edge repair with mitral valve clip and (2) transcatheter mitral valve replacement (TMVR).

Methods We conducted a systematic review of studies reporting the cerebrovascular adverse events after transcatheter mitral valve edge-to-edge repair and TMVR procedures. The primary endpoint was the incidence of cerebrovascular events as defined by the Mitral Valve Academic Research Consortium. An event that occurred within 30 days or during index hospitalisation was defined as periprocedural; otherwise it was defined as non-periprocedural. This study was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Aggregated study-level data were pooled using a random effect model. The quality of each study was appraised with the Hawker checklist, a method of systematically reviewing research from different paradigms.

Results Sixty studies totalling 28 155 patients undergoing edge-to-edge repair with mitral valve clip were included in the analysis. Periprocedural stroke and non-periprocedural stroke rates were 0.9% (95% CI 0.6 to 1.1) and 2.4% (95% CI 1.6 to 3.2), respectively. For TMVR procedures, 26 studies including 1910 patients were analysed. The estimated periprocedural stroke incidence was 1% (95% CI 0.5 to 1.8) compared with 7% (95% CI 0.8 to 18.5) for non-periprocedural stroke.

Conclusions Transcatheter mitral valve interventions are associated with low rates of cerebrovascular events. The exact mechanisms of these complications are still poorly understood given the relative paucity of good quality data.

Trial registration number CRD42019117257.

  • transcatheter valve interventions
  • mitral regurgitation
  • mitral stenosis
  • meta-analysis

https://doi.org/10.1136/heartjnl-2019-316331

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    Footnotes

    • Contributors GC, TMN, FB, SK, JR-C and J-MP contributed to the design of the work, analysis and interpretation of data. All authors contributed to the redaction of this manuscript. All authors approved this actual version. GC and J-MP are responsible for the overall content as guarantors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests SK is a member of Abbott Vascular advisory board and consultant for Claret Medical. JR-C holds the Canadian Research Chair 'Fondation Famille Jacques Larivière' for the Development of Structural Heart Disease Interventions, and has received research grants from Edwards Lifesciences and Medtronic. J-MP has received consulting fees from Abbott Vascular.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval This study complies with the Declaration of Helsinki. Due to the review nature of this work, approbation by an ethics committee was not necessary. However, for all studies analysed in our work, critical appraisement was performed with the Hawker checklist (which includes a criteria on ethical issues).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. All data are already published and available on the original article cited.