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Transcatheter Edge-to-Edge Mitral Valve Repair in Secondary Mitral Regurgitation: A Meta-Analysis of Mortality Outcomes
Session:
SESSÃO DE POSTERS 54 - INTERVENÇÃO MITRAL PERCUTÂNEA E CIRURGIA CARDÍACA
Speaker:
Barbara Lage Garcia
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.4 Interventional Cardiology - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Bárbara Lage Garcia; Emídio Mata; Margarida Castro; Luísa Pinheiro; Mariana Tinoco; João Português; Francisco Ferreira; Sílvia Ribeiro; Lucy Calvo; António Lourenço
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Secondary mitral regurgitation (SMR) in heart failure (HF) worsens outcomes and increases mortality. Transcatheter edge-to-edge mitral valve repair (MTEER) has emerged as a less invasive approach for patients with prohibitive surgical risk. This meta-analysis aims to assess the effects on mortality of MTEER plus guideline-directed medical therapy (GDMT) versus GDMT alone. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">PubMed, Cochrane, Scopus and Web of Science were searched (September, 2024) to identify Randomized Controlled Trials (RCT) comparing MTEER plus GDMT versus GDMT alone in adults with HF and SMR reporting on mortality. Data were pooled using an inverse variance random-effects model with mortality reported as hazard ratio (HR) with 95% confidence intervals (CI).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Of the 1558 entries, three RCTs (COAPT, MITRA-FR, and RESHAPE-HF2) met the inclusion criteria, totaling 1423 patients. At 12 months, all-cause mortality showed no significant difference (HR 0.91 CI 0.68–1.22). At 24 months, pooled estimate of all-cause mortality showed a borderline non-significant difference favoring MTEER (HR 0.76 CI 0.57-1.01). This result was driven by COAPT, which demonstrated a significant benefit with MTEER, and RESHAPE-HF2, which showed a non-significant trend. For cardiovascular (CV) death, only COAPT demonstrated a significant advantage with MTEER. When pooling all trials, a borderline non-significant difference favoring MTEER was observed (HR 0.77, CI 0.56–1.06). When analyzing the composite endpoint of all-cause mortality and first HF hospitalization at 24 months, both COAPT and RESHAPE-HF2 reported significant benefits from M-TEER over medical therapy alone. This finding was consistent in the pooled meta-analysis of the three trials (HR 0.71 CI 0.51–0.99).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">The RESHAPE-HF2 trial provides new insights into the efficacy of MTEER in SMR, complementing the findings of COAPT while contrasting with MITRA-FR. COAPT showed significant reductions in mortality and CV death, whereas RESHAPE-HF2 revealed a non-significant trend toward reduced all-cause and CV mortality, positioning MITRA-FR as an outlier. Differences in MR severity, GDMT adherence, and ventricular remodeling across trials may explain these variations. These findings support MTEER as a beneficial therapy to improve survival in well-selected patients, noting that trials excluded those with right ventricular dysfunction or concomitant valvular disease.</span></span></p>
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