Percutaneous mitral valve repair for secondary mitral valve regurgitation: A systematic review and meta-analysis

Kumar, Ashish; Al‐Khafaji, Jaafar; Shariff, Mariam; Vaz, Igor; Adalja, Devina; Doshi, Rajkumar

doi:10.1016/j.ejim.2020.02.019

Cited by 7 publications

(6 citation statements)

References 17 publications

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“…This might, therefore, influence the higher referral of symptomatic patients with heart failure who usually suffer from functional MR. The gradual reduction in the percentage of patients with functional MR was also associated with favorable results of studies and trials that involved patients with primary MR ( 4 , 9 , 15 ), along with controversial results from the European MITRA-FR trial regarding the outcome in patients with functional MR ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

Trends in Transcatheter Edge-to-Edge Mitral Valve Repair Over a Decade: Data From the MiTra ULM Registry

Nita

Schneider

Dahme

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveThis study sought to determine the potential change in trends in the baseline characteristics of patients with symptomatic severe mitral regurgitation who underwent transcatheter edge-to-edge mitral valve repair (M-TEER) over the last decade in a high-volume center.MethodologyThe investigation included 942 symptomatic patients with moderate-to-severe and severe mitral regurgitation who underwent transcatheter edge-to-edge repair (TEER) at our institution between January 2010 and March 2021. Patients were divided into quintiles and compared separately.ResultsPatients treated in the last quintile had significantly lower surgical risk (Euro Score 7.2 ± 6.8% in the last quintile vs. 10.9 ± 9.4% in the first quintile, p < 0.001), better New York Heart Association (NYHA) status (NYHA IV 14% in the last quintile vs. 40% in the first quintile, p < 0.001), lower NT-pro-BNP, and smaller left ventricle diameter than patients who were treated in the first quintile. There was no difference in age between quintiles. However, an invasive hemodynamic assessment did not show significant changes over the last decade (sPAP 51.35 ± 16.2 mmHg in the first quintile vs. 51.02 ± 14.5 mmHg in the last quintile, p = 0.90, pulmonary capillary wedge V wave 30.7 ± 14.8 mmHg in the first quintile vs. 27.4 ± 10.3 mmHg in the last quintile, p = 0.40). There is a significant trend of a gradually increasing proportion of patients with degenerative mitral regurgitation (MR) over the last 10 years (p < 0.001). The experience gained in the M-TEER procedure brought a significant reduction in fluoroscopy time and hospitalization duration. Medical therapy significantly changed over the last decade in terms of higher use of angiotensin receptor blockers (ARBs), lower use of angiotensin-converting enzyme inhibitors (ACEIs), and the introduction of angiotensin receptor-neprilysin inhibitors (ARNIs).ConclusionPatients undergoing the M-TEER procedure nowadays have lower surgical risk and are treated before they develop a significant left ventricular (LV) remodeling than before. The increasing expertise on the procedure over the last decade led to a rising number of patients with complex degenerative pathology being treated.

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Section: Discussionmentioning

confidence: 99%

Trends in Transcatheter Edge-to-Edge Mitral Valve Repair Over a Decade: Data From the MiTra ULM Registry

Nita

Schneider

Dahme

et al. 2022

Front. Cardiovasc. Med.

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“…The association between the severity of left ventricular dysfunction and clinical outcomes following intervention with MitraClip ® was established using a meta-regression in a recent metanalysis, partially explaining the contradicting results observed in the COAPT and the MITRA-FR trial [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Mitral Repair for Functional Mitral Regurgitation According to Left Ventricular Function: A Real-Life Propensity-Score Matched Study

Pascual

Carrasco-Chinchilla

Benito‐González

et al. 2020

JCM

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Background: Transcatheter mitral valve repair (TMVR) could improve survival in functional mitral regurgitation (FMR), but it is necessary to consider the influence of left ventricular ejection fraction (LVEF). Therefore, we compare the outcomes after TMVR with Mitraclip® between two groups according to LVEF. Methods: In an observational registry study, we compared the outcomes in patients with FMR who underwent TMVR with and without LVEF <30%. The primary endpoint was the combined one-year all-cause mortality and unplanned hospital readmissions due to HF. The secondary end-points were New York Heart Association (NYHA) functional class and mitral regurgitation (MR) severity. Propensity-score matching was used to create two groups with the same baseline characteristics, except for baseline LVEF. Results: Among 535 FMR eligible patients, 144 patients with LVEF <30% (group 1) and 144 with LVEF >30% (group 2) had similar propensity scores and were included in the analyses. The primary study endpoint was significantlly higher in group 1 (33.3% vs. 9.4%, p = 0.002). There was a maintained improvement in secondary endpoints without significant differences among groups. Conclusion: FMR patients with LVEF <30% treated with MitraClip® had higher mortality and readmissions than patients with LVEF ≥30% treated with the same device. However, both groups improved the NYHA functional class and MR severity.

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“…Overall, these studies suggest that pMVR treatment is associated with an improvement in symptoms, quality of life, functional status and, in some but not all studies, exercise capacity 8–12 . Indeed, although MR directly impairs exercise performance, 13 both the COAPT and the MITRA‐FR trials reported a null effect of pMVR on the 6‐min walk test (6MWT) 6,7,14 . Differently, several other studies suggested an improved exercise performance, 11,15 assessed in the great majority of reports by 6MWT.…”

Section: Introductionmentioning

confidence: 91%

“…[8][9][10][11][12] Indeed, although MR directly impairs exercise performance, 13 both the COAPT and the MITRA-FR trials reported a null effect of pMVR on the 6-min walk test (6MWT). 6,7,14 Differently, several other studies suggested an improved exercise performance, 11,15 assessed in the great majority of reports by 6MWT. Moreover, a severely impaired exercise performance seems to be associated with poor pMVR outcome at least in FMR patients.…”

Section: Introductionmentioning

confidence: 96%

Rest and exercise oxygen uptake and cardiac output changes 6 months after successful transcatheter mitral valve repair

et al. 2021

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Aims Changes in peak exercise oxygen uptake (VO2) and cardiac output (CO) 6 months after successful percutaneous edge‐to‐edge mitral valve repair (pMVR) in severe primary (PMR) and functional mitral regurgitation (FMR) patients are unknown. The aim of the study was to assess the efficacy of pMVR at rest by echocardiography, VO2 and CO (inert gas rebreathing) measurement and during cardiopulmonary exercise test with CO measurement. Methods and results We evaluated 145 and 115 patients at rest and 98 and 66 during exercise before and after pMVR, respectively. After successful pMVR, significant reductions in MR and NYHA class were observed in FMR and PMR patients. Cardiac ultrasound showed reverse remodelling (left ventricular end‐diastolic volume from 158 ± 63 mL to 147 ± 64, P < 0.001; ejection fraction from 51 ± 15 to 48 ± 14, P < 0.001; pulmonary artery systolic pressure (PASP) from 43 ± 13 to 38 ± 8 mmHg, P < 0.001) in the entire population. These changes were significant in PMR (n = 62) and a trend in FMR (n = 53), except for PASP, which decreased in both groups. At rest, CO and stroke volume (SV) increased in FMR with a concomitant reduction in arteriovenous O2 content difference [ΔC(a‐v)O2]. Peak exercise, CO and SV increased significantly in both groups (CO from 5.5 ± 1.4 L/min to 6.3 ± 1.5 and from 6.2 ± 2.4 to 6.7 ± 2.0, SV from 57 ± 19 mL to 66 ± 20 and from 62 ± 20 to 69 ± 20, in FMR and PMR, respectively), whereas peak VO2 was unchanged and ΔC(a‐v)O2 decreased. Conclusions These data confirm pMVR‐induced clinical improvement and reverse ventricular remodelling at a 6‐month analysis and show, in spite of an increase in CO, an unchanged exercise performance, which is achieved through a ‘more physiological’ blood flow distribution and O2 extraction behaviour. Direct rest and exercise CO should be measured to assess pMVR efficacy.

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Percutaneous mitral valve repair for secondary mitral valve regurgitation: A systematic review and meta-analysis

Cited by 7 publications

References 17 publications

Trends in Transcatheter Edge-to-Edge Mitral Valve Repair Over a Decade: Data From the MiTra ULM Registry

Trends in Transcatheter Edge-to-Edge Mitral Valve Repair Over a Decade: Data From the MiTra ULM Registry

Transcatheter Mitral Repair for Functional Mitral Regurgitation According to Left Ventricular Function: A Real-Life Propensity-Score Matched Study

Rest and exercise oxygen uptake and cardiac output changes 6 months after successful transcatheter mitral valve repair

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