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Review
. 2024 Nov 15;36(4):316-334.
doi: 10.37616/2212-5043.1399. eCollection 2024.

Comparative Efficacy and Safety of Transcatheter Mitral Valve Repair Versus Mitral-valve Surgery in Elderly Patients With Mitral Regurgitation: A Systematic Review and Meta-analysis

Saif Almuzainy #  1 , Mohamed Lemine #  1 , Rayan Aljubeh #  1 , Sami Alsalem  1
Affiliations
Review

Comparative Efficacy and Safety of Transcatheter Mitral Valve Repair Versus Mitral-valve Surgery in Elderly Patients With Mitral Regurgitation: A Systematic Review and Meta-analysis

Saif Almuzainy et al. J Saudi Heart Assoc. .

Abstract

Objectives: Mitral valve surgery is the reference treatment for severe symptomatic mitral regurgitation (MR). Percutaneous mitral valve interventions, such as the MitraClip procedure, offer an alternative, particularly for high-risk patients. The aim of this systematic review and meta-analysis was to analyze the safety and effectiveness of transcatheter mitral valve repair (TMVR) compared to surgical mitral valve repair or replacement (SMVR) in elderly patients with mitral regurgitation.

Methods: We searched PubMed, Scopus, Ovid, EBSCO, and ProQuest through July 2024. Eligible studies were randomized controlled trials and observational comparative studies of TMVR versus SMVR for patients with MR, reporting outcomes such as all-cause mortality, MR recurrence, stroke, myocardial infarction, and length of stay (LOS). Statistical analyses were performed using RevMan.

Results: Our search identified 3166 records, with 2756 screened and 21 studies included after review. The studies, comprising 20 retrospective cohorts and 1 randomized controlled trial with 20,900 patients, compared TMVR to SMVR. TMVR patients were significantly older than SMVR patients (MD 3.44 years; P < 0.00001). Mortality rates were similar at 30 days (relative risk (RR) 1.08; P = 0.79) and one year (RR 1.27; P = 0.18), but SMVR showed lower mortality at three years (RR 1.82; P = 0.006). SMVR also significantly reduced MR ≥ 3+ recurrence at 30 days (RR 6.95; P < 0.00001), one year (RR 3.31; P = 0.0001), and three years (RR 4.37; P < 0.00001). TMVR was associated with higher myocardial infarction rates (RR 1.58; P = 0.02) but reduced LOS (MD -4.88 days; P < 0.00001). Sensitivity analysis showed consistent results for recurrence of MR ≥ 3+ and variable outcomes for other metrics. Evidence of publication bias was noted for mortality at 30 days and LOS.

Conclusion: While TMVR with the MitraClip offers shorter hospital stays and is less invasive, SMVR provides better long-term survival and lower MR recurrence rates, emphasizing the need for a tailored approach based on patient risk profiles.

Keywords: MitraClip; Mitral regurgitation; Mortality; Recurrence; Surgical mitral valve repair; Transcatheter mitral valve repair.

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Conflict of interest statement

Conflict of interest: The authors of this study declare no conflict of interest. Disclosure of funding: This research did not receive any specific grant from funding agencies in the public, commercial. or not-for-profit sectors.

Figures

Fig. 1
Fig. 1
PRISMA study flow diagram.
Fig. 2
Fig. 2
Forest plot of risk ratios of mortality for MitraClip versus surgical mitral valve repair or replacement at 30 days, 1 year and 3 years. CI = confidence interval; M–H = Mantel-Haenszel.
Fig. 3
Fig. 3
Forest plot of risk ratios of MR recurrence for MitraClip versus surgical mitral valve repair or replacement at 30 days, 1 year, and >3 years. CI = confidence interval; M–H = Mantel-Haenszel.
Fig. 4
Fig. 4
Forest plot of pooled risk ratios of MI for MitraClip versus surgical mitral valve repair or replacement. CI = confidence interval; M–H = Mantel-Haenszel.
Fig. 5
Fig. 5
Forest plot of pooled risk ratios of stroke for MitraClip versus surgical mitral valve repair or replacement. CI = confidence interval; M–H = Mantel-Haenszel.
Fig. 6
Fig. 6
Forest plot of pooled effect estimates comparing length of stay for MitraClip versus surgical mitral valve repair or replacement. CI = confidence interval; IV = inverse variance.
See this image and copyright information in PMC

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