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Percutaneous Mitral Valve Repair vs Surgery on 12-Month Mortality/Hospitalizations in Mitral Regurgitation: A Meta-analysis of Clinical Trials and Propensity-Matched Cohorts
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; Luísa Pinheiro; Mariana Tinoco; João Português; Francisco Ferreira; Lucy Calvo; Sílvia Ribeiro; António Lourenço
Abstract
<p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="color:black">Surgery remains the standard treatment for severe mitral valve regurgitation (MR), but growing evidence highlights the potential role of mitral valve percutaneous edge-to-edge repair (MTEER). This meta-analysis aims to compare 12-month all-cause mortality and hospitalizations between MTEER and surgical intervention (SMVI).</span></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 and hospitalizations in MR patients treated with MTEER or SMVI. <span style="color:black">An inverse variance random-effects meta-analysis assessed event prevalence, with risk ratios (RR) and 95% confidence intervals (CI).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="color:black">From 1482 entries, two RCTs (MATTERHORN and EVEREST II) and three observational studies, totaling 1787 patients, met the inclusion criteria. Pooled RCT data showed no significant difference in 12-month mortality (RR 0.92; CI 0.46–1.81). Among observational studies, Amabile (2023) reported a significant benefit of SMVI, while Koschutnik (2022) (analyzing only primary MR) and Silaschi (2024) favored surgery without statistical significance. Reported data on 12-month hospitalizations could not be pooled statistically. The MATTERHORN trial reported cardiovascular hospitalization rates of 6.9% (MTEER) versus 11.9% (SMVI). Silaschi (2024) showed similar rates between groups: 8.7% (MTEER) vs. 8.5% (SMVI). Kaplan-Meier curves from Koschutnik (2022) for composite endpoint of death and heart failure hospitalization rates reported 20% for MTEER and 16% for SMVI.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="color:black">MTEER is associated with increased 12-month mortality, mainly driven by observational studies. As for 12-month hospitalizations, data remains inconclusive due to variability across studies and inability to pool results statistically. It is important to note that this meta-analysis, while including both observational studies and RCTs, observational studies utilized propensity score-matched data to minimize selection bias inherent to clinical practice, when assigning patients to each intervention. Nevertheless, RCTs excluded patients with right ventricular dysfunction or other severe valve disorders, such as tricuspid regurgitation, which were not excluded in the observational studies. Furthermore, the analysis combined populations with both primary and secondary mitral regurgitation (MR), which contributes to heterogeneity and may have influenced outcomes.</span></span></span></p>
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