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Review
. 2025 Jan 3;20(1):3.
doi: 10.1186/s13019-024-03218-4.

Meta-analysis of MitraClip and PASCAL for transcatheter mitral edge-to-edge repair

Mahmoud Balata  1 , Mohamed Ibrahim Gbreel  2 , Mohamed Hamouda Elkasaby  3 , Marwa Hassan  4 , Marc Ulrich Becher  5
Affiliations
Review

Meta-analysis of MitraClip and PASCAL for transcatheter mitral edge-to-edge repair

Mahmoud Balata et al. J Cardiothorac Surg. .

Abstract

Background: Despite the promising results of both MitraClip and PASCAL systems for the treatment of mitral regurgitation (MR), there is limited data on the comparison of both systems regarding their safety and efficacy. We aim to compare both systems for MR.

Materials and methods: Five databases were searched until October 2024. Original studies were only included and critically appraised using an adapted version of the Newcastle-Ottawa scale for observational cohort studies and the Cochrane risk of bias tool for randomized controlled trials. The risk ratio (RR) and mean difference (MD) with their corresponding 95% confidence interval (95% CI).

Results: From the database search, we identified 197 studies, of which eight studies comprising 1,612 patients who underwent transcatheter edge-to-edge repair with either MitraClip or PASCAL were included in this meta-analysis. The statistical analysis revealed no significant difference between the two devices in achieving a two-grade reduction in MR severity (RR = 0.95; 95% CI: [0.86, 1.04]; p = 0.28), one-grade reduction (RR = 1.17; 95% CI: [0.92, 1.49]; p = 0.19), or in cases with no improvement (RR = 1.23; 95% CI: [0.79, 1.90]; p = 0.36). Additionally, there were no significant differences between PASCAL and MitraClip regarding procedure time, procedural success, reinterventions, or all-cause mortality. However, PASCAL trended towards better residual MR reduction, although this was accompanied by moderate heterogeneity. Both devices demonstrated comparable safety profiles and were effective in reducing MR and improving cardiac function.

Conclusion: MitraClip and PASCAL devices showed comparable safety profiles and procedural success rates. However, the analysis did not reveal a statistically significant difference between the two devices in reducing the severity of MR.

Keywords: And Meta-analysis; MitraClip, PASCAL; Mitral Regurgitation; Review; Transcatheter edge-to-edge repair.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not Applicable. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of the literature search results
Fig. 2
Fig. 2
Cochrane risk of bias (ROB) tool version 2 for Lim et al. quality assessment as a randomized controlled trial
Fig. 3
Fig. 3
Forest plot of risk ratio (RR) and 95% confidence interval (CI) in the degree of MR declining
Fig. 4
Fig. 4
Forest plot of mean difference (MD) and 95% confidence interval (CI) in vena contracta width (mm)
Fig. 5
Fig. 5
Forest plot of mean difference (MD) and 95% confidence interval (CI) in effective regurgitant orifice area (EROA) (cm2) via proximal isovelocity surface area (PISA) method
Fig. 6
Fig. 6
Forest plot of mean difference (MD) and 95% confidence interval (CI) in trans mitral pressure gradient at discharge (mmHg)
See this image and copyright information in PMC

References

    1. Dziadzko V, Clavel M-A, Dziadzko M, Medina-Inojosa JR, Michelena H, Maalouf J, et al. Outcome and undertreatment of mitral regurgitation: a community cohort study. Lancet [Internet]. 2018;391:960–9. - PMC - PubMed
    1. Dziadzko V, Dziadzko M, Medina-Inojosa JR, Benfari G, Michelena HI, Crestanello JA, et al. Causes and mechanisms of isolated mitral regurgitation in the community: clinical context and outcome. Eur Heart J [Internet]. 2019;40:2194–202. - PubMed
    1. Delling FN, Rong J, Larson MG, Lehman B, Fuller D, Osypiuk E, et al. Evolution of mitral valve prolapse. Circulation [Internet]. 2016;133:1688–95. - PMC - PubMed
    1. Maisano F, Torracca L, Oppizzi M, Stefano PL, D’Addario G, La Canna G, et al. The edge-to-edge technique: a simplified method to correct mitral insufficiency1. Eur J Cardio-Thoracic Surg [Internet]. 1998;13:240–6. - PubMed
    1. Feldman T, Wasserman HS, Herrmann HC, Gray W, Block PC, Whitlow P, et al. Percutaneous mitral valve repair using the edge-to-edge technique. J Am Coll Cardiol [Internet]. 2005;46:2134–40. - PubMed

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