A review of comparative studies of MitraClip versus surgical repair for mitral regurgitation

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• 作者：Hisato Takagi^a ; ¹ ; ^{kfgth973@ybb.ne.jp} ; Tomo Ando^b ; ¹ ; Takuya Umemoto^a ; for the ALICE (All-Literature Investigation of Cardiovascular Evidence) Group
• 关键词：CI ; confidence interval ; EF ; ejection fraction ; EuroSCORE ; European System of Cardiac Operative Risk Evaluation ; EVEREST ; Endovascular Valve Edge-to-Edge Repair Study ; HR ; hazard ratio ; MD ; mean difference ; MR ; mitral regurgitation ; MV ; mitral valve ; OR ; odds ratio ; NYHA ; New York Heart Association ; RCT ; randomized controlled trial ; RD ; risk (rate) difference
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 February 2017
• 年：2017
• 卷：228
• 期：Complete
• 页码：289-294
• 全文大小：539 K
• 卷排序：228

文摘

We summarized comparative studies of MitraClip versus surgical repair for mitral regurgitation (MR) with a systematic literature search and meta-analytic estimates.MethodsMEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through June 2016. Eligible studies were randomized controlled or observational comparative studies of MitraClip versus surgical repair enrolling patients with MR and reporting early (30-day or in-hospital) or late (≥ 6-month including early) all-cause mortality. For each study, data regarding all-cause mortality and incidence of recurrent > 2 + MR in both groups were used to generate odds ratios (ORs). Alternatively, ORs or hazard ratios (HRs) for mortality and recurrent MR themselves were directly abstracted from each study.ResultsEight reports of 7 studies comparing MitraClip with surgical repair enrolling a total of 1015 patients with MR were identified and included. Pooled analyses demonstrated significantly higher age and logistic European System of Cardiac Operative Risk Evaluation and significantly lower ejection fraction in the MitraClip than surgical repair group, no significant difference in rate of women and patients with New York Heart Association functional class of > II, no statistically significant difference in early- (OR, 0.54; p = 0.08) and late-mortality (HR/OR, 1.17; p = 0.46), and significantly higher incidence of recurrent MR in the MitraClip than surgical repair group (HR/OR, 4.80; p < 0.00001).ConclusionsIn patients with MR, the MitraClip procedure achieves similar survival to surgical MV repair despite higher risk profiles. Recurrent MR, however, occurs more frequently (4.8-fold) after the MitraClip than surgical repair.