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The Impact of Transcatheter Edge-to-Edge Mitral Valve Repair on Functional Outcomes in Secondary Mitral Regurgitation: A Systematic Review and Meta-Analysis
Session:
SESSÃO DE POSTERS 31 - VALVULOPATIA MITRAL E TRICÚSPIDE - DIAGNÓSTICO E INTERVENÇÃO VALVULAR
Speaker:
Emídio Mata
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Emídio Mata; Bárbara Lage Garcia; Margarida Castro; Luísa Pinheiro; Margarida Castro; 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">Secondary mitral regurgitation (SMR) frequently complicates heart failure (HF) and is associated with poor functional status and outcomes. Transcatheter edge-to-edge mitral valve repair (MTEER) has emerged as a minimally invasive strategy to address SMR. This meta-analysis aimed to evaluate the impact of MTEER on functional outcomes in patients with HF and SMR. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">PubMed, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science were searched on September 2024, to identify randomized controlled trials (RCTs) comparing MTEER plus guideline-directed medical therapy (GDMT) versus GDMT alone in patients with HF and SMR reporting functional outcomes. Pooled data were analyzed using an inverse variance random-effects model, with continuous outcomes expressed as mean differences (MD) and categorical outcomes as risk ratio (RR). </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, with a total of 1423 patients. At 12 months, COAPT and RESHAPE-HF2 showed a significantly higher proportion of patients in NYHA class I/II in the MTEER group compared to the control group, whereas MITRA-FR did not observe this difference. COAPT was the only trial to sustain this benefit at 24 months. The pooled meta-analysis confirmed this benefit at both 12 months (RR 1.25 [1.04; 1.50]) and 24 months (RR 1.28 [1.05; 1.56]). Regarding the six-minute walk test, COAPT and RESHAPE-HF2 reported significant improvements in the MTEER group at 12 months, but MITRA-FR did not show similar results. The pooled estimate for the change in six-minute walk test distance did not reach statistical significance (MD 26.31 [-3.71; 56.33]). A sensitivity analysis using an alternative endpoint for MITRA-FR also confirmed the lack of significance (MD 24.94 [-8.96; 58.84]).</span></span></p> <p><span style="font-size:12.0pt"><span style="font-family:"Aptos",sans-serif">This meta-analysis highlights the potential of MTEER to improve functional status measured by NYHA classification. However, its impact on exercise capacity, as measured by the six-minute walk test, remains inconclusive. These discrepancies may reflect differences in patient populations, the severity of mitral regurgitation, and left ventricular remodeling across the included trials. The high heterogeneity observed in the meta-analysis warrants caution in interpreting these results. Future patient-level meta-analyses are needed to better understand the benefits of MTEER and identify patient subgroups most likely to experience functional improvement from this intervention.</span></span></p>
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