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Transcatheter Edge-to-Edge Mitral Valve Repair: A Meta-Analysis of Hospitalization Outcomes in Heart Failure and Secondary Mitral Regurgitation
Session:
SESSÃO DE POSTERS 20 - IC E INTERVENÇÃO VALVULAR
Speaker:
Emídio Mata
Congress:
CPC 2025
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Emídio Mata; Bárbara Lage Garcia; Margarida Castro; Luisa 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">Mitral regurgitation (MR) is the most common valvular disease in heart failure (HF), with secondary mitral regurgitation (SMR) as the dominant type. SMR exacerbates HF prognosis, increasing hospitalizations. Transcatheter mitral valve edge-to-edge repair (MTEER), has been investigated in recent years as an adjunct to guideline-directed medical therapy (GDMT). This meta-analysis assesses the effects on hospitalizations of MTEER plus GDMT versus GDMT alone.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">A systematic search (September 2024) of PubMed, Cochrane, Scopus, and Web of Science was performed to identify randomized controlled trials (RCTs) comparing hospitalizations of patients with HF and SMR randomized to MTEER plus GDMT or GDMT alone. Data was pooled using an inverse variance random-effects model, with hospitalizations expressed as hazard ratios (HR) 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">Among 1558 entries, three RCTs (COAPT, MITRA-FR, and RESHAPE-HF2) were included in the final analysis, with a total of 1423 patients. At 24 months, first HF hospitalization rate was significantly higher in the GDMT group in both COAPT and RESHAPE-HF2. The pooled analysis confirmed a significant benefit favoring MTEER (HR 0.66 CI 0.45–0.96). Similarly, when all HF hospitalizations (first and recurrent) were considered, both individual trials and the pooled analysis demonstrated consistent results at 24 months (HR 0.63 CI 0.49–0.81). Additionally, for the composite outcome of death and first HF hospitalization at 24 months, M-TEER showed significantly fewer events than GDMT (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">This analysis highlights the significant benefits of MTEER in reducing HF hospitalizations and composite outcomes of death and first HF hospitalization at 24 months compared to GDMT alone. Across trials there were differences in MR severity, GDMT adherence, medication availability and ventricular remodeling that could affect the outcomes. The consistency results across both COAPT and RESHAPE-HF2 with MITRA-FR as an outlier underscores the need for standardized patient selection criteria. These findings affirm MTEER as an effective intervention for HF and SMR patients, improving clinical outcomes and reducing the burden of hospitalizations, supporting its integration into treatment strategies for those already on GDMT.</span></span></p>
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