Prognostic impact of MitraClip in patients with left ventricular dysfunction and functional mitral valve regurgitation: A comprehensive meta-analysis of RCTs and adjusted observational studies

The real prognostic impact of MitraClip in patients with significant functional mitral regurgitation (FMR) and left ventricular (LV) dysfunction remains to be elucidated. Two randomized controlled trials (RCTs) with conflicting results have been recently published. We conducted a comprehensive meta-...

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Bibliographic Details
Published in:International journal of cardiology 2019-09, Vol.290, p.70-76
Main Authors: Bertaina, Maurizio, Galluzzo, Alessandro, D'Ascenzo, Fabrizio, Conrotto, Federico, Grosso Marra, Walter, Frea, Simone, Alunni, Gianluca, Crimi, Gabriele, Moretti, Claudio, Montefusco, Antonio, D'Amico, Maurizio, Perl, Leor, Rinaldi, Mauro, Giustetto, Carla, De Ferrari, Gaetano Maria
Format: Article
Language:English
Subjects:
FMR
HFrEF
Humans
MitraClip
Mitral Valve Insufficiency - diagnosis
Mitral Valve Insufficiency - epidemiology
Mitral Valve Insufficiency - surgery
Observational Studies as Topic - methods
OMT
Patient Readmission - trends
Prognosis
Randomized Controlled Trials as Topic - methods
Surgical Instruments - trends
Ventricular Dysfunction, Left - diagnosis
Ventricular Dysfunction, Left - epidemiology
Ventricular Dysfunction, Left - surgery
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Summary:The real prognostic impact of MitraClip in patients with significant functional mitral regurgitation (FMR) and left ventricular (LV) dysfunction remains to be elucidated. Two randomized controlled trials (RCTs) with conflicting results have been recently published. We conducted a comprehensive meta-analysis of all RCTs and adjusted observational studies to evaluate the clinical impact of percutaneous mitral valve repair when compared with optimal medical therapy (OMT) alone, in patients with symptomatic FMR and LV dysfunction. Death from any cause and heart failure rehospitalizations at the longest available follow-up were the primary endpoints. Cardiac death, one year and short-term death were the secondary ones. 2255 patients (1207 for MitraClip and 1048 for OMT-only) from 8 studies (2 RCTs and 6 observational studies) were included. At a median (mid-term) follow-up of 438 days (IQR 360–625) MitraClip was associated with a significant reduction of all-cause death (odds Ratio [OR] 0.55, 95%CI 0.41–0.73, p 
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2019.05.015