Highlights
- •MitraClip in secondary MR reduces the risk of all-cause mortality.
- •MitraClip in secondary MR reduces the risk of readmission events.
- •MitraClip in high left ventricular end diastolic volume at baseline has poor outcome.
- •Elderly patients have better mortality benefits with Mitraclip intervention.
- •Patients randomized in COAPT and MITR HF trial were not homogenous.
Abstract
Background
The first two randomized control trials (RCTs) studying the role of MitraClip in patients
with secondary mitral regurgitation (MR) had antagonizing results. We, therefore,
performed an updated meta-analysis of RCTs and propensity score-matched observational
studies investigating the role of MitraClips in patients with secondary MR. A novel
method of Kaplan Meier Curve reconstruction from derived individual patient data will
be used to compare the survival probability of control groups in COAPT and MITRA HF
trail, and hence, access inter-study heterogeneity.
Methods
Medline and Cochrane databases was used for systematic search. We used the Mantel-Haenszel
method with a random-effect model to calculate risk ratio (RR) with 95% confidence
interval (CI) and inverse variance method with a random-effect model to calculate
the mean difference (MD) with 95% confidence interval (CI). We used a fixed-effect
approach for meta-regression.
Results
MitraClip reduced the risk of all-cause mortality [RR: 0.72, CI: 0.55–0.95, P value = 0.02, I2 = 55%, χ2P-value = 0.08] and readmission [RR: 0.62, CI: 0.42–0.92, P value = 0.02, I2 = 90%, χ2P-value<0.01] at two years follow-up. There was no effect of MitraClip on change in
cardiovascular mortality and 6 m walking distance at 12 months follow-up. Meta-regression
indicated left ventricular end diastolic volume and age among the factors affecting
outcomes. Reconstructed Kaplan Meier curves confirmed considerable heterogeneity among
patients randomized in MITRA HF and COAPT trial.
Conclusion
The present meta-analysis confirms the beneficial role of percutaneous mitral valve
repair in patients with secondary MR. However, all the results were associated with
considerable heterogeneity.
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Article info
Publication history
Published online: February 21, 2020
Accepted:
February 16,
2020
Received in revised form:
February 14,
2020
Received:
December 16,
2019
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
