Comparative analysis of postoperative outcomes following surgical and transcatheter edge-to-edge mitral valve repair for secondary mitral regurgitation: a meta-analysis & systematic review

TL;DR

This study compares surgical and transcatheter mitral valve repair for secondary mitral regurgitation, finding better mid-term outcomes with surgery.

Contribution

The study provides a meta-analysis comparing surgical and transcatheter approaches for secondary MR, revealing novel insights into their relative effectiveness.

Findings

Surgical mitral valve repair (SMVr) showed lower mid-term mortality and reintervention rates compared to transcatheter edge-to-edge repair (TEER).

SMVr was associated with improved functional status and fewer cases of recurrent mitral regurgitation.

Both approaches had similar in-hospital mortality rates, but SMVr had higher risks of neurological events.

Abstract

Mitral regurgitation (MR) affects approximately millions of people globally, predominantly older adults, leading to 0.88 million DALY and 34,000 deaths in 2019. Both ESC and ACC/AHA guidelines recommend intervention either surgery or transcatheter for secondary MR despite optimal medical therapy. The comparative effectiveness of SMVr vs. TEER for managing secondary MR remains uncertain, prompting a systematic review to assess outcomes, safety, and long-term implications.

This systematic review and meta-analysis were carried out and documented according to the PRISMA 2020 guidelines. Searches were conducted in the Embase, EBSCOHost, Medline, Sage, Science Direct, and Scopus databases.

This meta-analysis included eight studies and 6224 patients. Both SMVr and TEER showed similar rate of in-hospital mortality (3.85% vs. 2.83%, RR = 2.54; 95% CI = 0.59–10.95; p = 0.21; I2 = 57%), while SMVr was associated with a significantly lower incidence of post-discharge residual MR compared to TEER (RR = 0.27; 95% CI = 0.16–0.45; p < 0.01; I2 = 0%). However, SMVr showed a higher incidence of neurologic events, including stroke or TIA (1.89% vs. 0.94%, RR = 1.88; 95% CI = 1.16–3.05; p = 0.001; I2 = 0%). The rates of acute renal failure (5.26% vs. 5.29%, RR = 1.23; 95% CI = 0.84–1.80; p = 0.28; I2 = 9%) and postoperative myocardial infarction (1.91% vs. 1.81%, RR = 1.07; 95% CI = 0.71–1.62; p = 0.73; I2 = 0%) were higher in the SMVr group, but this was statistically insignificant. Mid-term mortality analysis favored SMVr over TEER, with lower mortality rates observed in SMVr patients (Rate Ratio 0.74; 95% CI, 0.63–0.88; p < 0.001; I²=27%), lower reintervention rates (RR = 0.29, p < 0.001), lower incidence rate ratio of recurrent MR (Rate Ratio = 0.56; 95% CI = 0.40–0.78; p = 0.0005; I2 = 0%) and heart failure rehospitalization (Rate Ratio = 0.81; 95% CI = 0.68–0.97; p = 0.02; I2 = 5%). SMVr patients were more likely to experience improvement in functional status (NYHA) compared to TEER patients (RR = 1.14, p < 0.006).

SMVr has demonstrated better mid-term outcomes than TEER, including lower mortality rates, fewer reinterventions and rehospitalization, and improved functional status in patients with mitral regurgitation.

identifier [CRD42024538771].

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