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Comparing 30-Day Outcomes of Transcatheter Edge-to-Edge Repair vs Surgery in Mitral Valve Regurgitation: A Meta-Analysis of Clinical Trials and Propensity-Matched Cohorts
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:
25.3 Non-coronary Cardiac Intervention
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">Surgery remains the standard treatment for mitral valve regurgitation (MR), with transcatheter edge-to-edge repair (MTEER) typically reserved for high-risk patients. While surgery is more invasive and carries significant risks, MTEER offers a less invasive alternative. This meta-analysis evaluates the 30-day outcomes of both interventions.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">In October 2024, PubMed, Cochrane, Scopus, and Web of Science were searched for randomized control trials (RCT) and propensity-matched cohort studies comparing MR patients undergoing either MTEER and SMVI. Pooled data was analyzed using a random-effects inverse variance meta-analysis of risk ratios (RR) and 95% confidence intervals (CI).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">From 1482 entries, two RCTs (MATTERHORN and EVEREST II) and three observational studies meet inclusion criteria with a total of 1782 patients. At 30 days, all-cause mortality did not significantly differ between interventions (RR 0.72; CI 0.26–2.00), though more deaths occurred immediately post-intervention in the SMVI group (3.4%; 8/236) compared to MTEER (2.1%; 7/331), a trend specifically seen in pooled data from the RCTs (RR 0.48; CI 0.14–1.72). Regarding other safety outcomes at 30 days, pooled statistical analyses could not be performed due to limited reported data. The surgical group experienced more complications, mainly driven by major bleeding. Surgical group had higher rates of stroke (3.0% vs 0.6%), major bleeding (30.9% vs 8.9%), prolonged ventilation (>48 hours), deep wound infections, renal failure requiring dialysis, and new-onset atrial fibrillation (13.6% vs 1.8%). Reintervention rates were similar between groups (5.3% vs 5.1%).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">The findings highlight distinct differences in 30-day outcomes. Surgery is associated with higher complication rates, while MTEER demonstrates fewer adverse events and comparable reintervention rates, with a nonsignificant trend toward higher mortality in the surgical group. However, EVEREST II did not account for patients with unsuccessful MTEER subsequently referred for surgery in outpatient settings, likely underestimating reintervention rates for MTEER. Nevertheless, it is also important to note that during the EVEREST trial, MTEER was a novel technique with limited operator experience, resulting in higher failure rates. The pooled population, combining primary and secondary MR cases, along with comparator groups using different techniques, may introduce heterogeneity that could influence the results.</span></span></p>
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