scholarly journals Transcatheter Mitral Valve Repair in Patients with Heart Failure: A Meta-Analysis

Cardiology ◽  
2020 ◽  
pp. 1-7
Author(s):  
Ajay Vallakati ◽  
Ayesha K Hasan ◽  
Konstantinos Dean Boudoulas
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Medical Therapy ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Valve Repair ◽  
Heart Failure Patients ◽  
Transcatheter Mitral Valve Repair ◽  
Secondary Mr

<b><i>Background:</i></b> Severe secondary mitral regurgitation (MR) is associated with poor prognosis in heart failure patients with left ventricular systolic dysfunction. Few observational and randomized controlled studies demonstrated the efficacy of transcatheter mitral valve repair in heart failure patients with significant MR. A meta-analysis of published studies was performed to evaluate the role of transcatheter mitral valve repair using the MitraClip device in heart failure patients with significant secondary MR. <b><i>Methods:</i></b> A literature search was performed using PubMed, Cochran CENTRAL, and Embase databases using the search terms “percutaneous mitral valve repair” or “transcatheter mitral valve repair” and “heart failure.” Studies that compared medical therapy plus transcatheter mitral valve repair using MitraClip to medical therapy alone in heart failure patients with significant secondary MR were included for pooled analysis. A random-effects model with the Mantel-Haenszel method was used to analyze the data. <b><i>Results:</i></b> Four studies, 2 randomized controlled and 2 nonrandomized studies met the criteria for analysis. Pooled analysis included a total of 1,421 patients, of which 746 patients underwent transcatheter mitral valve repair and 675 patients received medical therapy alone. When compared to medical therapy, transcatheter mitral valve repair significantly decreased all-cause mortality (OR 0.58, 95% CI 0.37–0.91; <i>p</i> = 0.02). A trend toward significant reduction in rehospitalizations (OR 0.35, 95% CI 0.12–1.00; <i>p</i> = 0.05) was also observed. Periprocedural complications ranged from 7.5 to 12.6%. <b><i>Conclusion:</i></b> Evidence from pooled analysis suggests that transcatheter mitral valve repair using MitraClip on top of medical therapy, in appropriately selected symptomatic heart failure patients with significant secondary MR, provides survival benefit and may decrease hospitalizations when compared with guideline-directed medical therapy alone.

Sex-Specific Outcomes of Transcatheter Mitral-Valve Repair and Medical Therapy for Mitral Regurgitation in Heart Failure

2021 ◽  
Author(s):  
Ioanna Kosmidou ◽  
JoAnn Lindenfeld ◽  
William T. Abraham ◽  
Michael J. Rinaldi ◽  
Samir R. Kapadia ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Medical Therapy ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair

5944Mortality advantage of mitraclip in patients with heart failure and mitral regurgitation: an updated meta-analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Ashukem ◽  
M D Bhavi Pandya ◽  
M D Verma Diva Ratyan
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Medical Therapy ◽  
Absolute Risk ◽  
Meta Analysis ◽  
Optimal Medical Therapy ◽  
Number Needed To Treat ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair

Abstract Background In patients with symptomatic mitral regurgitation who are high risk for surgery, transcatheter mitral-valve repair has been shown to be safe and improve clinical outcomes. However, its impact on survival has shown conflicting results in recent trials. Methods PubMed, EMBASE and Google Scholar databases were queried for all trials about MitraClip compared with optimal medical therapy Results This meta-analysis of 9 trials including 3199 patients, found that patients treated with MitraClip compared to optimal medical therapy had similar 30-day mortality (OR 0.64, 95% CI 0.32- 1.28) while at 12-months MitraClip was associated with significantly lower all-cause mortality (OR 0.46, 95% CI 0.33- 0.65). Absolute risk reduction was 13.9% and number needed to treat to save 1 life at 12 months was 7.2. Figure 1 Conclusions In this meta-analysis, transcatheter mitral valve repair with MitraClip was associated with significantly lower mortality at 12 months of follow up

Meta-analysis confirms improvement of hospitalizations and all-cause mortality of transcatheter mitral valve repair in functional mitral regurgitation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Noutsias ◽  
M Matiakis ◽  
B Bigalke ◽  
D Sedding ◽  
A Rigopoulos
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Meta Analysis ◽  
Functional Mitral Regurgitation ◽  
Clinical Effects ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
All Cause Mortality

Abstract Background Moderate-to-severe or severe functional mitral regurgitation (FMR) is associated with higher rates of hospitalizations and with increased mortality in heart failure (HF). Transcatheter mitral valve repair by MitraClip® implantation (TMVrMC) may effectively reduce severe MR, and is associated with symptomatic improvement. However, the long-term clinical effects of this procedure are not well defined. Aims We analyzed outcomes for rehospitalization and survival in HF patients with moderate-to-severe or severe FMR treated by either medical treatment (MT) only versus TMVrMC+MT by meta-analysis. Methods and results By systematic search of bibliographic databases, we evaluated publications comparing HF patients with FMR treated by MT only versus treatment by MT combined with TMVrMC. Studies with a minimum of 25 enrolled patients and a follow/up period of at least 12 months were deemed eligible for this meta-analysis. We identified n=7 studies enrolling 2,884 HFrEF patients, divided into two study arms: TMVrMC+MT (n=1,618), versus FMR patients receiving MT only (n=1,266). At 12 months, there was a significant reduction in all-cause mortality favoring TMVrMC+MT (OR: 0.65; CI 95% 0.53–0.79), compared with the MT only patients. At 24 months, a significant reduction of all-cause mortality in the TMVrMC+MT patient group (OR: 0.54; CI: 95%: 0.43–0.67; p&lt;0.001) was calculated. TMVrMC+MT was associated with significantly lower rates of unplanned re-admissions for heart failure compared with MT only at 12 months (OR: 0.69; 95%; CI 0.53–0.89; p&lt;0.001) and at 24 months (OR: 0.53; 95% CI: 0.39–0.71; p&lt;0.001). In one publication, a survival benefit of TMVrMC+MT over MT alone was shown at 5 years post intervention (HR: 0.75; 95% CI: 0.69–0.94; p=0.012) after weighting for propensity score and controlling for age. Conclusions This meta-analysis on n=2,884 patients with moderate-to-severe or severe FMR reveals that TMVrMC+MT, as compared with MT alone, is associated with a significant reduction of rehospitalizations and improvement of survival up to 24 months after MitraClip implantation. However, the discordant results of 2 randomized controlled trials (MITRA-FR and COAPT) warrant further clarification, i.e. of the eligible FMR patient profiles who might benefit from TMVrMC+MT in terms of improvement of prognosis. These data imply additional evidence for TMVrMC in eligible HF patients with relevant FMR, which might be important for an update of the corresponding guidelines. Funding Acknowledgement Type of funding source: None

Percutaneous Mitral Valve Repair Vs. Stand-Alone Medical Therapy in Patients with Functional Mitral Regurgitation and Heart Failure

2020 ◽  
Vol 21 (1) ◽  
pp. 52-60 ◽  
Author(s):  
Tomás Benito-González ◽  
Rodrigo Estévez-Loureiro ◽  
Pedro A. Villablanca ◽  
Patrizio Armeni ◽  
Ignacio Iglesias-Gárriz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Medical Therapy ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
Percutaneous Mitral Valve Repair

5034Is stroke an issue after transcatheter mitral valve repair? A systematic review and meta-analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Barros Da Silva ◽  
J P Sousa ◽  
B Oliveiros ◽  
H Donato ◽  
L Goncalves ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
De Novo ◽  
Meta Analysis ◽  
Stroke Rate ◽  
Valve Repair ◽  
Stroke Incidence ◽  
Transcatheter Mitral Valve Repair ◽  
Post Procedure

Abstract Background Transcatheter mitral valve repair (TMVR) is a minimally invasive therapeutic procedure used as an alternative to surgery for mitral valve regurgitation in high risk patients. This technique creates a double orifice area, which might be comparable to a mitral prosthesis or mitral stenosis. So far, no strict antithrombotic therapy has been recommended and different post-procedure protocols are being currently applied. Objectives To assess stroke rate after TMVR, comparing it with surgical mitral valve repair (SMVR) and optimal medical treatment (OMT). Methods We systematically searched PubMed, Embase and Cochrane databases, in December 2018, for both interventional or observational studies comparing TMVR with SMVR and/or OMT in the treatment of severe mitral regurgitation. Only studies including data on post-procedure stroke incidence were selected. Two authors independently screened articles for inclusion, risk of bias and data extraction. Random-effects meta-analysis for TMVR, SMVR and OMT were performed. Due to the low number of pooled events, a cumulative meta-analysis was subsequently implemented. The meta-analysis was registered on the Prospero database. Results 15 studies were selected for qualitative analysis and, among these, 10 were included in the quantitative analyses (7 of TMVR vs. SMVR and 3 of TMVR vs. OMT), providing a total of 1881 patients. TMVR patients were older and had higher surgical risk scores than SMVR patients. Groups were homogeneous regarding previous atrial fibrillation rate (pooled OR 1.45 [0.82–2.55]), whereas post-procedure de novo atrial fibrillation was more frequent in SMVR when compared with TMVR (pooled OR 0.20 [0.06–0.7]). Although the pooled stroke rate was numerically lower in the TMVR group, there was no statistically difference in the stroke incidence between TMVR and SMVR (pooled OR 0.49 [0.17, 1.42], p=0.19, I2= 0%) – Panel A. On the other hand, cumulative meta-analysis was able to show a significantly lower stroke rate in TMVR, when compared to SMVR (OR 0.4 [0.40, 0.67], p<0.05). As for TMVR vs. OMT, no difference in stroke rate was identified (pooled OR 1.09 [0.60, 1.97], p=0.79, I2=0%) – Panel B. Forest Plots – Stroke incidence Conclusions Post-procedure TMVR stroke rate was similar to that of patients managed with OMT only. For the same outcome, results favored TMVR when compared with SMVR, which might be related to its lower incidence of post-procedure de novo atrial fibrillation. These findings may prove insightful to future recommendations regarding the conundrum of the best antithrombotic strategy, particularly for patients with atrial fibrillation.

scholarly journals Transcatheter Mitral-Valve Repair in Patients with Heart Failure

2018 ◽  
Vol 379 (24) ◽  
pp. 2307-2318 ◽  
Author(s):  
Gregg W. Stone ◽  
JoAnn Lindenfeld ◽  
William T. Abraham ◽  
Saibal Kar ◽  
D. Scott Lim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
Patients With Heart Failure

scholarly journals Mitral Regurgitation International Database (MIDA) Score Predicts Outcome in Patients With Heart Failure Undergoing Transcatheter Edge‐to‐Edge Mitral Valve Repair

2021 ◽  
Author(s):  
Refik Kavsur ◽  
Maximilian Spieker ◽  
Christos Iliadis ◽  
Clemens Metze ◽  
Moritz Transier ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Rank Test ◽  
International Database ◽  
Valve Repair ◽  
Log Rank Test ◽  
Transcatheter Mitral Valve Repair

Background Optimizing risk stratification in patients undergoing transcatheter mitral valve repair is an ongoing challenge. The Mitral Regurgitation International Database (MIDA) score represents a user‐friendly mortality risk stratification tool that is validated on a large‐scale registry of patients with degenerative mitral regurgitation (MR). We here assessed the potential benefit of the MIDA risk score for patients with functional or degenerative MR undergoing transcatheter mitral valve repair. Methods and Results In total, 680 patients undergoing MitraClip implantation were stratified according to MIDA score tertiles into a low (0–7), intermediate (8–9), and a high (10–12) MIDA score group. MR was assessed in follow‐up echocardiograms in 416 patients at 323±169 days after transcatheter mitral valve repair. During 2‐year follow‐up, 8.2% (15/182) of patients with low, 21.3% (64/300) with intermediate, and 26.3% (52/198) with high MIDA score died (log‐rank test P <0.001). Hazard of all‐cause mortality increased by 13% (95% CI, 3%–25%) with every additional point of the MIDA score. Subanalysis of 431 patients with functional MR showed similar results. Furthermore, rates of a combined end point of mortality and hospitalization for heart failure were higher with increasing MIDA score (30% [54/182], 38% [113/300] and 48% [94/198], respectively, log‐rank test P =0.001). Frequency of residual MR ≥II at follow‐up increased with increasing MIDA score group (33%, 44%, and 59%, respectively, P <0.001). Conclusions The MIDA mortality risk score maintains its predictive utility in patients undergoing transcatheter mitral valve repair, regardless of MR cause. Moreover, it was predictive of worse event‐free survival regarding a combined end point of mortality and hospitalization for heart failure, and was associated with postprocedural residual MR ≥II and MR recurrence.

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