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Meta-analysis on MitraClip implantation for functional mitral regurgitation

Session Poster Session 4

Speaker Assistant Professor Michel Noutsias

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Multidisciplinary Interventions
  • Session type : Poster Session

Authors : M Noutsias (Halle,DE), M Matiakis (Halle,DE), M Ali (Halle,DE), E Abate (Halle,DE), H Melnyk (Halle,DE), B Bigalke (Berlin,DE), AG Rigopoulos (Halle,DE)

Authors:
M Noutsias1 , M Matiakis1 , M Ali1 , E Abate1 , H Melnyk1 , B Bigalke2 , AG Rigopoulos1 , 1University Clinic Halle (Saale), Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology - Halle - Germany , 2Charite - Campus Benjamin Franklin - Berlin - Germany ,

Citation:

In patients with heart failure reduced left ventricular ejection fraction (HFrEF), moderate-to-severe or severe functional mitral regurgitation (FMR) may is associated with high rate of hospitalizations for heart failure and with increased mortality. Transcatheter mitral valve repair (TMVR) by MitraClip® implantation may effectively reduce severe MR; however, the long-term clinical effects of this procedure are not well defined.

Aims: We analyzed outcomes for rehospitalization and survival in heart failure patients with moderate-to-severe or severe functional mitral regurgitation (FMR) treated by either medical treatment (MT) only versus transcatheter mitral valve repair (TMVR) by MitraClip® implantation + MT by meta-analysis.

Methods & Results: By systematic search of bibliographic databases, we evaluated publications comparing heart failure patients with FMR treated by MT only versus treatment by MT combined with TMVR (by Mitraclip® implantation). Studies with a minimum of 25 enrolled patients and a follow/up period of at least 12 months were deemed eligible for this meta-analysis. We identified n=8 studies enrolling 2,960 HFrEF patients, divided into two study arms: MTVR by MitraClip® implantation and MT (n=1,692), versus FMR patients receiving MT only (n=1,268). At 12 months, there was a significant reduction in all-cause mortality favoring TMVR+MT (OR: 0.67; CI 95% 0.55-0.81), as well as a reduction of unplanned rehospitalizations (OR: 0.64; 95%; CI 0.54-0.77), compared with the MT only patients. At 24 months, there was a significant reduction of all-cause mortality in the TMVR+MT patient group (OR: 0.50; CI: 95%: 0.38-0.66; p<0.001). TMVR+MT was associated with significantly lower rates of unplanned re-admissions for heart failure compared with MT only at 12 months (OR: 0.69; 95% CI: 0.53-0.89; p<0.001) and at 24 months (OR: 0.53; 95% CI: 0.39-0.71; p<0.001).

Conclusions: This meta-analysis on n=2,960 patients with moderate-to-severe or severe FMR reveals that TMVR+MT, as compared with MT alone, is associated with a significant reduction of rehospitalizations and improvement of survival. These data imply additional evidence for TMVR by Mitraclip® in eligible heart failure patients with relevant FMR, which might be important for an update of the corresponding guidelines.

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