Stroke after transcatheter edge-to-edge mitral valve repair: a systematic review and meta-analysis

Silva, Patricia Barros da; Sousa, José Pedro; Oliveiros, Bárbara; Donato, Helena; Costa, Marco; Gonçalves, Lino; Teixeira, Rogério

doi:10.4244/eij-d-19-00602

Cited by 18 publications

(30 citation statements)

References 35 publications

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“…Despite the risk of paradox embolism through an iASD, a meta-analysis found no difference in stroke rates in patients after MC therapy compared to patients on optimal medical therapy. The postprocedural stroke rate tends to be decreased compared to surgical mitral therapy (p=0.19), which might be due to a higher incidence of de novo atrial fibrillation in surgical patients [ 48 •]. On the other hand, a diffusion MRI study reported an incidence of 86% new silent cerebral lesions after TEER in a cohort of 27 patients with a significant reduction in neurocognitive function tests if >3 cerebral lesions were present.…”

Section: Complicationsmentioning

confidence: 99%

“…High rates (11.7%) of newly diagnosed AF were described at the Pilot European Sentinel Registry, whereas lower rates of 1.2% were found in the GRASP registry [ 23 , 53 ]. A meta-analysis of low cohort number studies showed an incidence of 2.4% of de novo AF after MC [ 48 •]. The clinical impact of de novo AF after TEER will have to be further investigated.…”

Section: Complicationsmentioning

confidence: 99%

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Complications Following MitraClip Implantation

et al. 2021

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Purpose of Review To provide a detailed overview of complications associated with MitraClip therapy and its development over time with the aim to alert physicians for early recognition of complications and to offer treatment strategies for each complication, if possible. Recent Findings The MitraClip system (MC) is the leading transcatheter technique to treat mitral regurgitation (MR) and has been established as a safe procedure with very low adverse event rates compared to mitral surgery at intermediate to high risk or in secondary MR. Lately, the fourth MC generation has been launched with novel technical features to facilitate device handling, decrease complication rates, and allow the treatment of even complex lesions. Summary Although the complication rate is low, adverse events are associated with increased morbidity and mortality. The most common complications are bleeding, acute kidney failure, procedure-induced mitral stenosis, and an iatrogenic atrial septal defect with unknown clinical impact.

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Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Complications Following MitraClip Implantation

et al. 2021

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“…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 number of primary studies included in the individual SRs ranged from 9 to 14.…”

Section: Systematic Reviewsmentioning

confidence: 99%

“…The number of primary studies included in the individual SRs ranged from 9 to 14. In 1 SR of 12 studies, 13 which had a broader scope with an additional comparator of interest, 7 retrospective cohort studies were relevant to this report, while 5 were out of the scope. The 4 included SRs reported including 42 primary studies.…”

Section: Systematic Reviewsmentioning

confidence: 99%

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

Peprah¹,

Gunn²,

Walter³

2021

cjht

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Four systematic reviews (SRs) and 6 retrospective cohort studies provided evidence for the clinical effectiveness of transcatheter mitral valve repair (TMVR) versus open heart conventional surgical mitral valve repair or replacement (SMVR) in patients with primary or secondary mitral regurgitation (MR). No relevant evidence regarding the cost-effectiveness of TMVR versus SMVR in patients with primary or secondary MR was identified; therefore, no summary can be provided. There was evidence indicating a statistically significant difference in favour of TMVR over SMVR regarding the odds of post-procedure bleeding, need for permanent pacemaker implantation, 30-day readmission, and a shorter duration of hospitalization. There was evidence suggesting a statistically significant difference in favour of SMVR over TMVR regarding the odds of recurrent MR, the need for reoperation, and mortality rate (i.e., during hospitalization, at 1 year, and > 3 years). Also, compared with TMVR, the likelihood of residual MR grade > 2 or freedom from MR grade ≥ 2 or ≥ 3 at 4 years was statistically significantly lower or higher, respectively, with SMVR. Evidence regarding the comparative clinical effectiveness of TMVR versus SMVR concerning stroke, acute kidney injury (AKI), cardiogenic shock, and death during hospitalization was conflicting and inconclusive. There was no evidence of a significant difference between the 2 interventions regarding overall mortality or mortality at 5 years, overall survival, freedom from cardiac death at 4 years, cardiac arrest, acute myocardial infarction (MI), and respiratory or vascular complications. A major limitation of the evidence was that it derives from studies of low or unknown quality and risk of bias, Furthermore, all the findings are confounded by differences in patient selection, which reflect the approved indications for the interventions but prevent a direct comparison between the TMVR and SMVR groups.

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Bleeding and thrombotic risk of different antiplatelet regimens posttranscatheter edge‐to‐edge mitral valve repair in patients with an indication for oral anticoagulation: Results from an all‐comers national registry

Claeys,

Aminian,

Bartunek

et al. 2023

Cathet Cardio Intervent

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BackgroundEvidence‐based recommendations for antithrombotic treatment in patients who have an indication for oral anticoagulation (OAC) after transcatheter edge‐to‐edge mitral valve repair (TEER) are lacking.AimsTo compare bleeding and thrombotic risk for different antithrombotic regimens post‐TEER with MitraClip in an unselected population with the need for OACs.MethodsBleeding and thrombotic complications (stroke and myocardial infarction) up to 3 months after TEER with mitraclip were evaluated in 322 consecutive pts with an indication for OACs. These endpoints were defined by the Mitral Valve Academic Research Consortium criteria and were compared between two antithrombotic regimens: single antithrombotic therapy with OAC (single ATT) and double/triple ATT with a combination of OAC and aspirin and/or clopidogrel (combined ATT).ResultsCollectively, 108 (34%) patients received single ATT, 203 (63%) received double ATT and 11 (3%) received triple ATT. Bleeding events occurred in 67 patients (20.9%), with access site related events being the most frequent cause (37%). Bleeding complications were observed more frequently in the combined ATT group than in the single ATT group: 24% versus 14% [p = 0.03, adjusted RR: 0.55 (0.3–0.98)]. Within the combined group, the bleeding risk was 23% in the double ATT and 45% in the triple ATT group. Thrombotic complications occurred in only three patients (0.9%), and all belonged to the combined ATT group.ConclusionsIn patients with an indication for OACs, withholding of antiplatelet therapy post‐TEER with Mitraclip was associated with a 45% reduction in bleeding and without a signal of increased thrombotic risk.

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Stroke after transcatheter edge-to-edge mitral valve repair: a systematic review and meta-analysis

Cited by 18 publications

References 35 publications

Complications Following MitraClip Implantation

Complications Following MitraClip Implantation

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

Bleeding and thrombotic risk of different antiplatelet regimens posttranscatheter edge‐to‐edge mitral valve repair in patients with an indication for oral anticoagulation: Results from an all‐comers national registry

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