Open AccessComparison of Transcatheter Mitral-Valve Repair and Surgical Mitral-Valve Repair in Elderly Patients with Mitral Regurgitation
Author(s) -
Haoyong Yuan,
Tingting Wei,
Zhongshi Wu,
Ting Lü,
Jinlan Chen,
Yifan Zeng,
Ling Tan
Publication year - 2021
Publication title -
the heart surgery forum/the heart surgery forum
Language(s) - English
Resource type - Journals
eISSN - 1522-6662
pISSN - 1098-3511
DOI - 10.1532/hsf.3433
Subject(s) - medicine , mitraclip , mitral valve repair , mitral regurgitation , ejection fraction , cardiology , mitral valve , hazard ratio , incidence (geometry) , surgery , mitral valve annuloplasty , heart failure , confidence interval , physics , optics
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.