Does the clinical effectiveness of Mitraclip compare with surgical repair for mitral regurgitation?
File(s)
Published version
Author(s)
Type
Journal Article
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.
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.
Date Issued
2021-03
Date Acceptance
2020-11-22
Citation
Journal of Cardiac Surgery, 2021, 36 (3), pp.1103-1119
ISSN
0886-0440
Publisher
Wiley
Start Page
1103
End Page
1119
Journal / Book Title
Journal of Cardiac Surgery
Volume
36
Issue
3
Copyright Statement
© 2021 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000606587800001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Surgery
Cardiovascular System & Cardiology
mitraclip
mitral valve repair
mitral regurgitation
TO-EDGE REPAIR
VALVE REPAIR
PERCUTANEOUS REPAIR
SURGERY
RECOMMENDATIONS
METAANALYSIS
MORTALITY
SURVIVAL
THERAPY
TRIAL
Publication Status
Published
Date Publish Online
2021-01-11