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. 2021 Jan;10(1):1-14.
doi: 10.21037/acs-2020-mv-24.

An updated meta-analysis of MitraClip versus surgery for mitral regurgitation

Nicholas A Oh  1   2 , Polydoros N Kampaktsis  3 , Michele Gallo  4 , Alvise Guariento  5 , Viktoria Weixler  6 , Steven J Staffa  7 , Dimitrios V Avgerinos  8 , Andrea Colli  9 , Ilias P Doulamis  1
Affiliations

An updated meta-analysis of MitraClip versus surgery for mitral regurgitation

Nicholas A Oh et al. Ann Cardiothorac Surg. 2021 Jan.

Abstract

Background: Although studies demonstrate its feasibility, there is ongoing debate on the short and long-term outcomes of MitraClip versus surgical repair or mitral valve replacement (MVR). The objective of this meta-analysis is to compare the safety, morbidity, mortality and long-term function following MitraClip compared to MVR.

Methods: Articles were searched in PubMed and Cochrane databases for studies comparing outcomes of MitraClip and surgery on December 1, 2019. Eligible prospective, retrospective, randomized and non-randomized studies were reviewed.

Results: A total of nine studies (n=1,873, MitraClip =533, MVR =644) were eligible for review. At baseline, MitraClip patients had more comorbidities than MVR patients, including myocardial infarction (P<0.001), chronic obstructive pulmonary disease (P=0.022) and chronic kidney disease (P<0.001). MitraClip was associated with shorter length of stay (-3.86 days; 95% CI, -4.73 to -2.99; P<0.01) with a similar safety profile. Residual moderate-to-severe mitral regurgitation was more frequent in MitraClip at discharge (OR, 2.81; 95% CI, 1.39-5.69; P<0.01) and at five years (OR, 2.46; 95% CI, 1.54-3.94; P<0.01), and there was a higher need for reoperation on the MitraClip group at latest follow-up (OR, 5.28; 95% CI, 3.43-8.11; P<0.01). The overall mortality was comparable between the two groups (HR, 2.06; 95% CI, 0.98-4.29; P=0.06) for a mean follow-up of 4.8 years.

Conclusions: Compared to surgery, MitraClip demonstrates a similar safety profile and shorter length of stay in high-risk patients, at the expense of increased residual mitral regurgitation and higher reoperation rate. Despite this, long term mortality appears comparable between the two techniques, suggesting that a patient-tailored approach will lead to optimal results.

Keywords: MitraClip; mitral regurgitation (MR); mitral valve (MV); mitral valve repair.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram according to Preferred Reporting Items for Systemic Review and Meta-Analyses guidelines. N, number of studies.
Figure 2
Figure 2
Forest plot of the comparison between MitraClip and MVR for length of stay (A), 30-day mortality (B), acute kidney injury (C), and neurologic injury (D). N, number of studies; SD, standard deviation; CI, confidence interval; MVR, mitral valve repair/replacement.
Figure 3
Figure 3
Forest plot of the comparison between MitraClip and MVR for 1-year mortality (A), 5-year mortality (B), and adjusted mortality (C). MVR, mitral valve repair/replacement; CI, confidence interval.
Figure 4
Figure 4
Forest plot of the comparison between MitraClip and MVR for mitral regurgitation at discharge (A), mitral regurgitation at 5 years (B), and mitral valve re-operations at follow-up (C). MVR, mitral valve repair/replacement; CI, confidence interval.
Figure 5
Figure 5
Forest plot of the comparison between MitraClip and MVR for 30-day mortality (A), 1-year mortality (B), 5-year mortality (C), mitral regurgitation at discharge (D), mitral regurgitation at 5 years (E) mitral valve re-operation at follow-up (F) and adjusted mortality at latest follow-up (G). MVR, mitral valve repair/replacement; CI, confidence interval.
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