Does the clinical effectiveness of Mitraclip compare with surgical repair for mitral regurgitation?

Abstract

Background Surgical repair of the mitral valve has long been the established therapy for degenerative mitral regurgitation (MR). Newer transcatheter methods over the last decade, such as the MitraClip, serve to restore mitral function with reduced procedural burden and enhanced recovery. This study aims to compare the shortterm and midterm outcomes of MitraClip insertion with surgical repair for MR. Methods A systematic review of the literature was conducted for studies comparing outcomes between surgical repair and MitraClip. The initial search returned 1850 titles, from which 12 studies satisfied the inclusion criteria (one randomized controlled trial and 11 retrospective studies). Results The final analysis comprised 4219 patients (MitraClip 1210; surgery 3009). Operative mortality was not different between the groups (odds ratio [OR] = 1.63, 95% confidence interval [CI]: [0.63−4.23]; p = .317). Length of hospital stay was significantly shorter in the MitraClip group (standardized mean difference [SMD] = 0.882, 95% CI: [0.77–0.99]; p < .001) with considerable heterogeneity (I2 > 90%; p < .001). The rate of reoperation on the mitral valve was lower in the surgical group (OR = 0.392; 95% CI: [0.188−0.817]; p = .012) as was the rate of MR recurrence grade moderate or above (OR = 0.29; 95% CI: [0.19−0.46]; p < .001) during midterm follow up. Long term survival (4–5 years) was also similar between both groups (hazard ratio = 0.70; 95% CI: [0.35−1.41]; p = .323). Conclusions This study highlights the superior midterm durability of surgical valve repair for MR compared with the MitraClip.

Comparative efficacy of 5 surgical methods in the treatment of mitral regurgitation: a systematic review and network meta-analysis

“…Although most of articles record the left ventricular ejection fraction (LVEF) values before, due to the large clinical heterogeneity between the studies, the postoperative EF value was not included in the outcome indicators for comparison. A Meta study in China [35] once reported that the Percutaneous Mitral Valve Clipping (Mitra-Clip treatment) can improve the cardiac function of patients with mitral regurgitation and heart failure to a certain extent, but further studies are still needed to prove its conclusions; recent studies by Khader [36] and others in the UK have also repeatedly emphasized the mid-term durability of MR valve surgical repair is better than Mitra-Clip.…”

Transcatheter Mitral Edge-to-Edge Repair in Patients with Primary or Secondary Mitral Regurgitation

“…1 The disease is categorized into primary (also called degenerative) or secondary (also called functional), where primary MR is caused by an abnormality of 1 or more components of the valve apparatus (e.g., leaflets, papillary muscles, annulus); whereas, secondary MR is due to another heart disease such as coronary heart disease, cardiac ischemia, and heart failure. 2,3 MR is a progressive disease and considered the second most frequent valve disease. 1,4 The incidence of MR increases with age, with a prevalence of over 9% in patients ≥ 75 years of age.…”

“…Three of the included SRs were published in 2021 3,4,8 while 1 was published in 2020. 13 Each SR was based on relevant literature retrieved by systematic searches conducted in multiple databases (i.e., 2 or more) between December 2018 and June 2020.…”

“…The individual studies included in the SRs were retrospective cohort studies except for 2 RCTs, 1 of which was common to 3 of the SRs. 3,4,8 Additional details regarding the characteristics of the included SRs have been provided in Appendix 2.…”

“…Each of the 4 included SRs had lead authors from the UK, 3 the US, 4 China, 8 or Portugal. 13 Four of the 6 retrospective cohort studies were conducted in the US 6,14,17,18 while 1 was conducted in Germany 15 and another 1 in Italy.…”