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Valvular heart disease
Original research article
Outcome after percutaneous edge-to-edge mitral repair for functional and degenerative mitral regurgitation: a systematic review and meta-analysis
  1. Mauro Chiarito1,
  2. Matteo Pagnesi2,
  3. Enrico Antonio Martino3,
  4. Michele Pighi4,
  5. Andrea Scotti2,
  6. Giuseppe Biondi-Zoccai5,
  7. Azeem Latib2,6,
  8. Giovanni Landoni3,7,
  9. Carlo Di Mario4,
  10. Alberto Margonato2,7,
  11. Francesco Maisano8,
  12. Ted Feldman9,
  13. Ottavio Alfieri7,10,
  14. Antonio Colombo2,6,7,
  15. Cosmo Godino2
  1. 1Interventional Cardiology Unit, Humanitas Clinical and Research Center, Rozzano, Italy
  2. 2Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
  3. 3Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
  4. 4Department of Cardiology, NIHR Biomedical Research Unit, Royal Brompton Hospital, London, UK
  5. 5Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Roma, and Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Latina, Italy
  6. 6Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
  7. 7Vita-Salute San Raffaele University, Milan, Italy
  8. 8UniversitätsSpital Zurich, University Heart Center, Zurich, Switzerland
  9. 9NorthShore University HealthSystem, Evanston, Illinois
  10. 10Cardiac Surgery Unit, San Raffaele Hospital, Milan, Italy
  1. Correspondence to Dr Cosmo Godino, Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; godino.cosmo{at}hsr.it

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.

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

https://doi.org/10.1136/heartjnl-2017-311412

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    Footnotes

    • Contributors Study conception and design: MC, CG, MP. Acquisition of data: MC, MP, EAM, MP, AS. Analysis and interpretation of data: MC, MP, EAM, GB-Z, GL, TF, OA, CG. Drafting of manuscript: MC, CG. Critical revision: GB-Z, AL, GL, MP, CDM, AM, FM, TF, OA, AC, CG.

    • Competing interests FM has received consulting fees from Abbott Vascular, Medtronic, ValtechCardio, and St. Jude Medical; is a founder of 4Tech; and has received royalties from Edwards Lifesciences. TF has received consulting fees and research support from Abbott, Boston Scientific, Edwards and WL Gore. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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

    • Correction notice Since this paper was first published online, the study variables in the top row of table 2 have been reformatted. They are now appearing above the correct columns.

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