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Impact of Etiology, Age and Left Ventricular Ejection Fraction on 12-Month Mortality Effects of Transcatheter Edge-to-Edge Repair vs. Surgery: A Meta-Regression Analysis
Session:
SESSÃO DE POSTERS 54 - INTERVENÇÃO MITRAL PERCUTÂNEA E CIRURGIA CARDÍACA
Speaker:
Emídio Mata
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Emídio Mata; Bárbara Lage Garcia; Margarida Castro; Luísa Pinheiro; Mariana Tinoco; João Português; Francisco Ferreira; Lucy Calvo; Sílvia Ribeiro; António Lourenço
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Background:</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">The optimal treatment approach for mitral regurgitation (MR) has recently been debated, particularly concerning outcomes between transcatheter edge-to-edge repair (MTEER) and surgical mitral valve intervention (SMVI). This meta-regression evaluates how the proportion of secondary MR, patient age, and left ventricular ejection fraction (LVEF) influence the 12-month all-cause mortality risk ratio (RR) between MTEER and SMVI.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Methods:</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">A systematic search (October 2024) of PubMed, Cochrane, Scopus, and Web of Science identified randomized control trials (RCT) and propensity-matched observational studies comparing 12-month all-cause mortality in significant MR patients treated with MTEER or SMVI. A mixed-effects meta-regression assessed the influence of secondary MR proportion, age, and LVEF on the 12-month mortality RR.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Results:</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">From 1482 articles, two RCTs (MATTERHORN and EVEREST II) and three observational studies enrolling a total of 1787 patients meet inclusion criteria. For a cohort composed only of primary MR cases, the baseline RR of 12-month mortality was estimated at 1.607 [0.622-4.150]. A decrease in RR by a factor of 0.984 [0.889-1.090] was observed per 10% increase in the prevalence of secondary MR. The pooled mean age did not show a significant effect. Meta-regression revealed a baseline RR of 12-month mortality for a 60-year patient of 0.561 [0.039-8.034] with an increase by a factor of 1.071 [0.842-1.363] per additional year. As of LVEF impact, estimated baseline RR for the outcome at a LVEF baseline of 50% was 1.444 [0.999-2.088]. For every additional 5% increase, the RR increased by a factor of 1.038 [0.804-1.340].</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Discussion:</span></span></p> <p><span style="font-size:12.0pt"><span style="font-family:"Aptos",sans-serif">This meta-regression did not identify significant moderators of the 12-month all-cause mortality RR between MTEER and SMVI. However, the borderline confidence interval observed for the effect of secondary MR prevalence suggests that MTEER may provide better outcomes in patients with secondary MR, has seen in subgroups analyses of individual trials. The increasing RR trend with higher LVEF, though not significant, suggests SMVI is favored in higher LVEF or while MTEER is preferred in significant dysfunction. Age showed very limited predictive value for the 12-month mortality RR between MTEER and SMVI. These trends warrants further investigation in larger datasets as small number of included studies (n = 5) limits the statistical power of the analysis and increases the risk of overfitting.</span></span></p>
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