Comparison of Transcatheter Mitral-Valve Repair and Surgical Mitral-Valve Repair in Elderly Patients with Mitral Regurgitation

Authors

  • Haoyong Yuan, MD Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China https://orcid.org/0000-0002-6401-3914
  • Tingting Wei, MD Department of Pediatrics, Hunan Provincial Maternal and Child Health Care Hospital, Hunan, China
  • Zhongshi Wu, MD Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Hunan, China
  • Ting Lu, MD Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
  • Jinlan Chen, MD Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
  • Yifan Zeng, MD Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
  • Ling Tan, MD Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
  • Can Huang, MD Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China

DOI:

https://doi.org/10.1532/hsf.3433

Keywords:

MitraClip therapy, transcather mitral valve repair, surgical mitral valve repair, mitral valve regurgitation

Abstract

Purpose: To summarize comparative studies of MitraClip versus surgical repair in typical, real-world elderly patients with severe mitral regurgitation (MR) and analyze the safety and effectiveness of these therapeutic options.

Methods: PubMed, Medline, Embase, and Cochrane Controlled Register of Trials (CENTRAL) were searched for comparative studies of transcatheter mitral-valve repair (TMVR) versus surgical mitral-valve repair (SMVR) in elderly patients with severe MR from January 2000 to June 2020. Statistical pooling for incidence estimates was performed according to a random-effects model with generic inverse-variance weighting, computing risk estimates with 95% confidence intervals (CIs), using RevMan 5.3.

Results: A total of 14 reports comparing MitraClip with SMVR, enrolling 3355 patients with severe MR, were included in this study. Mean age, Logistic EuroSCORE, and incidence of diabetes mellitus (DM) were significantly higher in the MitraClip group, except the rate of patients with New York Heart Association (NYHA) class of >II and mean value of ejection fraction (EF). The arithmetic mean of freedom from acute mobility was similar. The 2 groups had equal all-cause mortality at 30 days, but different at 1 year (14% versus 9%) and 3 years in 7 studies (37% versus 25%). The freedom from recurrent MR ≥3+ was 88% and 97.3% at 30 days, 76.0% and 90.0% at 1 year, and 79% and 95% at 3 years in the MitraClip and surgical repair group, respectively.

Conclusion: Although MitraClip is safe and effective in selected high-risk patients, the surgery may be the only gold standard for “gray” patients. Further studies are needed to determine whether MitraClip should be recommended.

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Published

2021-02-15

How to Cite

Yuan, H., Wei, T., Wu, Z., Lu, T., Chen, J., Zeng, Y., Tan, L., & Huang, C. (2021). Comparison of Transcatheter Mitral-Valve Repair and Surgical Mitral-Valve Repair in Elderly Patients with Mitral Regurgitation. The Heart Surgery Forum, 24(1), E108-E115. https://doi.org/10.1532/hsf.3433

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