Cerebrovascular events after transcatheter mitral valve interventions: a systematic review and meta-analysis

Abstract

ObjectiveCurrent guidelines support the use of transcatheter mitral valve interventions to treat some selected high-risk patients with significant mitral valvulopathy. As with any other interventional cardiac procedure, concerns have been raised about cerebrovascular event. The aim of this systematic review and meta-analysis was to determine the incidence of cerebrovascular events following (1) transcatheter mitral valve edge-to-edge repair with mitral valve clip and (2) transcatheter mitral valve replacement (TMVR).MethodsWe conducted a systematic review of studies reporting the cerebrovascular adverse events after transcatheter mitral valve edge-to-edge repair and TMVR procedures. The primary endpoint was the incidence of cerebrovascular events as defined by the Mitral Valve Academic Research Consortium. An event that occurred within 30 days or during index hospitalisation was defined as periprocedural; otherwise it was defined as non-periprocedural. This study was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Aggregated study-level data were pooled using a random effect model. The quality of each study was appraised with the Hawker checklist, a method of systematically reviewing research from different paradigms.ResultsSixty studies totalling 28 155 patients undergoing edge-to-edge repair with mitral valve clip were included in the analysis. Periprocedural stroke and non-periprocedural stroke rates were 0.9% (95% CI 0.6 to 1.1) and 2.4% (95% CI 1.6 to 3.2), respectively. For TMVR procedures, 26 studies including 1910 patients were analysed. The estimated periprocedural stroke incidence was 1% (95% CI 0.5 to 1.8) compared with 7% (95% CI 0.8 to 18.5) for non-periprocedural stroke.ConclusionsTranscatheter mitral valve interventions are associated with low rates of cerebrovascular events. The exact mechanisms of these complications are still poorly understood given the relative paucity of good quality data.Trial registration numberCRD42019117257.

Mortality and morbidity of surgical and transcatheter mitral valve repair in octogenarians: A systematic review

“…In‐hospital mortality, however, is comparable between octogenarians and younger populations who receive SMVr, with our reported average being 2.6% and a previous meta‐analysis reporting 3.1% 28 . Previous literature on younger populations who receive TMVr has reported in‐hospital mortality at 2.8% and 30‐day mortality from 3.1% to 3.2%, 28,30,32 comparable to the 1.4% and 3.3% mortality rates reported for octogenarians receiving TMVr in‐hospital and after 30 days, respectively. Where octogenarians differ from younger populations is in midterm mortality rates.…”

“…More importantly, the morbidity incidence rates experienced by octogenarians in this review are similar to morbidity rates in younger populations that receive MVr. Median stroke incidence for octogenarians receiving TMVr and SMVr were 0.25% and 2.7%, respectively, similar to the incidence of the general population that receive MVr at 2.3% for all MVr types and 3.3% for TMVr specifically 16,30 . Incidences of AKI after MVr in younger populations have previously been identified at 7.9% for all MVr types and 14.7% for TMVr, 16,31 which was also comparable to octogenarians who experienced 8% and 7.4% average AKI incidence for SMVr and TMVr, respectively.…”

“…Median stroke incidence for octogenarians receiving TMVr and SMVr were 0.25% and 2.7%, respectively, similar to the incidence of the general population that receive MVr at 2.3% for all MVr types and 3.3% for TMVr specifically. 16,30 Incidences of AKI after MVr in younger populations have previously been identified at 7.9% for all MVr types and 14.7% for TMVr, 16,31 which was also comparable to octogenarians who experienced 8% and 7.4% average AKI incidence for SMVr and TMVr, respectively. Average incidences of infection in octogenarians were 7% and 1% for SMVr and TMVr, respectively, less than the 11.6% incidence identified in younger populations who received MVr in previous studies.…”

“…Where octogenarians differ from younger populations is in midterm mortality rates. Midterm mortality outcomes in octogenarians were significantly higher than those reported in the general population who received MVr, with 1‐year follow‐ups experiencing 15.8%–20.2% mortality across all MVr types 16,30,35 and octogenarians experiencing mortality rates of 22.3% for SMVr and 52.6% for TMVr. This comparison, however, does not account for the difference in life expectancy between octogenarians and younger patients.…”

Acute stroke intervention for acute embolic procedural strokes performed by cardiologists

“…Cerebral embolization during cardiovascular interventions, resulting in acute ischemic stroke, is a serious complication. Although uncommon, it can occur during any procedure manipulating the heart, ascending aorta or the aortic arch 1–3 and is associated with high morbidity and mortality if untreated 4,5 …”