Author + information
- Mauro Chiarito1,
- Matteo Pagnesi2,
- Enrico Martino3,
- Michele Pighi4,
- Andrea Scotti5,
- Giuseppe Biondi-Zoccai6,
- Azeem Latib7,
- Giovanni Landoni8,
- Alberto Margonato2,
- Francesco Maisano9,
- Ted Feldman10,
- Ottavio Alfieri8,
- Antonio Colombo11 and
- Cosmo Godino2
- 1Humanitas Clinical Institute, Milan, Milan, Italy
- 2San Raffaele Scientific Institute, Milan, Milan, Italy
- 3San Gerardo Hospital, Monza, Monza and Brianza, Italy
- 4Montreal Heart Institute, Montreal, Quebec, Canada
- 5Cardiothoracic Vascular Department, San Raffaele Scientific Institute, Milano, Milan, Italy
- 6Sapienza University of Rome, Latina, Latina, Italy
- 7Interventional Cardiology Institute San Raffaele Hospital, Milan, Milan, Italy
- 8San Raffaele Hospital, Milan, Milan, Italy
- 9UniversitätsSpital Zürich, Zürich, Switzerland
- 10Evanston Hospital, Evanston, Illinois, United States
- 11San Raffaele Scientific Institute, Milan, Italy
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.
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 etiology were excluded. This study is registered with PROSPERO.
A total of 9 studies investigating the mid-term outcome of percutaneous edge-to-edge repair in functional versus degenerative MR patients were included in the meta-analysis (n=2,615). At 1-year there were not significant differences among groups in terms of patients with MR grade≤2 (719/1,304 vs. 295/504; 58 vs. 54%; RR 1.12; 95% CI: 0.86–1.47; 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: 0.38–0.97; p=0.04). 1-year mortality rate was 16% (408/2,498) and similar among groups (RR 1.26; 95% CI: 0.90–1.77; p=0.18). Functional MR group showed significantly higher percentage of patients in NYHA class III/IV (234/1,480 vs. 49/583; 16 vs. 8%; p<0.01) and re-hospitalization 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 embolization (no events reported in both groups) at 1 year.
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, randomized studies are ongoing and awaited to fully assess the clinical impact of the procedure in these two different MR etiologies.
STRUCTURAL: Valvular Disease: Mitral