Percutaneous Mitral Valve Repair versus Optimal Medical Therapy in Patients with Functional Mitral Regurgitation: A Systematic Review and Meta-Analysis

Objectives. To compare percutaneous mitral valve repair (PMVR) with optimal medical therapy (OMT) in patients with heart failure (HF) and severe functional mitral regurgitation (FMR). Background. Many patients with HF and FMR are not suitable for surgical valve replacement and remain symptomatic des...

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Bibliographic Details
Published in:Journal of interventional cardiology 2019-01, Vol.2019 (2019), p.1-10
Main Authors: Doukky, Rami, Alkhouli, Mohamad, Naidu, Srihari S., Syed, Intekhab Askari, Khan, Safi U., Khan, Muhammad Arbaz Arshad, Khan, Muhammad Shahzeb, Siddiqi, Tariq Jamal, Usman, Muhammad Shariq, Lodhi, Muhammad Uzair, Rahim, Mustafa
Format: Article
Language:English
Subjects:
Analysis
Bias
Cardiac patients
Cardiovascular Agents - therapeutic use
Cardiovascular diseases
Care and treatment
Catheters
Congestive heart failure
Health aspects
Heart failure
Heart Failure - therapy
Heart Valve Prosthesis Implantation
Humans
Medical research
Medicine, Experimental
Meta-analysis
Mitral valve
Mitral Valve - surgery
Mitral valve insufficiency
Mitral Valve Insufficiency - drug therapy
Mitral Valve Insufficiency - mortality
Mitral Valve Insufficiency - surgery
Mortality
Patients
Regurgitation
Sensitivity analysis
Studies
Systematic review
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Summary:Objectives. To compare percutaneous mitral valve repair (PMVR) with optimal medical therapy (OMT) in patients with heart failure (HF) and severe functional mitral regurgitation (FMR). Background. Many patients with HF and FMR are not suitable for surgical valve replacement and remain symptomatic despite maximal OMT. PMVR has recently emerged as an alternative solution. Methods. We performed a systematic review and a meta-analysis to address this question. Cochrane CENTRAL, MEDLINE, and Scopus were searched for randomized (RCT) and nonrandomized studies comparing PMVR with OMT in patients with HF and FMR. Primary endpoint was all-cause midterm mortality (at 1 and 2 years). Secondary endpoints were 30-day mortality and cardiovascular mortality and HF hospitalizations, at maximum follow-up. Studies including mixed cohort of degenerative and functional MR were allowed initially but were excluded in a secondary sensitivity analysis for each of the study’s end points. This meta-analysis was performed following the publication of two RCTs (MITRA-FR and COAPT). Results. Eight studies (six observational, two RCTs) comprising 3,009 patients were included in the meta-analysis. In comparison with OMT, PMVR significantly reduced 1-year mortality (RR: 0.70 [0.56, 0.87]; p=0.002; I2=47.6%), 2-year mortality (RR: 0.63 [0.55, 0.73]; p
ISSN:0896-4327
1540-8183
DOI:10.1155/2019/2753146