Clinical outcomes of percutaneous mitral valve repair with MitraClip for the management of functional mitral regurgitation

Abstract

Objectives To evaluate the safety and efficacy of percutaneous mitral valve repair for the management of functional mitral insufficiency. Background Severe FMR is present in 25–30% of patients with heart failure and is an independent predictor of mortality and hospitalizations in patients with both ischemic and nonischemic cardiomyopathy. MitraClip therapy has been approved for high surgical risk patients with primary mitral regurgitation. Recent studies including two randomized trials have yielded conflicting results in terms of its clinical efficacy and outcomes for FMR. A quantitative evaluation and synthesis of this information are essential in elucidating the role of MitraClip repair for FMR. Methods We performed a literature search using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from September 2008 to September 2018. Studies comparing percutaneous mitral valve repair using the MitraClip device against conservative therapy for the management of functional mitral regurgitation were included. Results Seven studies with 1,174 patients in MitraClip group and 1,015 patients in medical therapy group met inclusion criteria. The 12‐month mortality in the MitraClip group was 18.4% compared with 25.9% in the medical therapy group (odds ratio [OR]: 0.65 [0.50, 0.86]; p < .002). The rate of readmission at 12 months was 29.9% in the MitraClip group compared with 54.1% in the medical therapy group (OR: 040 [0.32–0.49]; p < .0001. The prognostic efficacy of MitraClip repair appears to be more substantial over longer follow‐up period over medical therapy alone. Conclusions Based on the results of this meta‐analysis, percutaneous mitral valve repair with MitraClip appears to be superior to medical therapy for symptomatic moderate‐to‐severe functional mitral insufficiency. Further clinical research is needed to identify the ideal patient subgroups who receive maximum benefit with the MitraClip therapy.

Mitraclip Plus Medical Therapy Versus Medical Therapy Alone for Functional Mitral Regurgitation: A Meta-Analysis

“…To our knowledge this is the first metaanalysis comparing MitraClip along with medical therapy versus medical therapy alone selectively in FMR patients only. Previous meta-analyses performed on the same topic have included either observational studies or included patients with degenerative mitral regurgitation (DMR) in their analysis [15,16]. Given the pathophysiology of DMR patients is fundamentally distinct from that of FMR patients, the inclusion of DMR patients along with FMR patients in these meta-analyses may potentially act as a confounding factor and may, therefore, skew the overall results in either direction.…”

Selection of the Optimal Candidate to MitraClip for Secondary Mitral Regurgitation: Beyond Mitral Valve Morphology

“…Two later meta-analyses (62,63), documented a significant reduction in mortality and risk of HF hospitalization among patients who received MitraClip+OMT as compared with OMT in secondary MR. The prognostic efficacy of PMVR seems to be a function of time, with mortality rates continuously diverging over a longer follow-up period (62).…”

Does the clinical effectiveness of Mitraclip compare with surgical repair for mitral regurgitation?

“…It involves femoral venous and transseptal access to the left atrium, followed by the insertion of a clip through the mitral orifice into the left ventricle to hold the edges of the mitral leaflets and allow vertical coaptation 10 . MitraClip has been proven to be superior to medical therapy for the management of functional MR, 11 demonstrated in a single randomized controlled trial (RCT) and observational studies.…”