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A Meta-Analysis on 12-Month Efficacy Outcomes of Transcatheter Mitral Valve Repair vs Surgery on Mitral Regurgitation
Session:
SESSÃO DE POSTERS 50 - DIAGNÓSTICO E PROGNÓSTICO NA CIRURGIA CARDÍACA
Speaker:
Barbara Lage Garcia
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:
Bárbara Lage Garcia; Emídio Mata; 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"><span style="color:black">Mitral valve regurgitation (MR) is a serious condition, typically treated with surgery. However, mitral valve transcatheter edge-to-edge repair (MTEER) has emerged as a less invasive alternative. This meta-analysis compares 12-months efficacy outcomes between MTEER and surgical mitral valve intervention (SMVI).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">PubMed, Cochrane, Scopus, and Web of Science (on October 2024) were searched for randomized control trials (RCT) and propensity-matched cohort studies focused on significant MR treated with MTEER or SMVI, reporting on outcomes of interest at 12 months<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="font-family:"Aptos Display",sans-serif"><span style="color:black">Two RCTs (MATTERHORN and EVEREST II) and three observational studies, totaling 1782 patients, were included. At 12 months, mitral valve (MV) reintervention was more frequent in the MTEER group (9.6%; 84/877) than in the surgical group (3.3%; 26/777), though this difference was not statistically significant (RR 2.51; CI 0.83-7.66). The higher rate in the MTEER group was primarily driven by the EVEREST II trial (20.4% vs 2.2%) and the Amabile (2023) study (6.5% vs 2.2%). Regarding recurrence of significant MR (defined as MR grade ≥3), rates were significantly higher in the MTEER group (13.1%; 34/259) compared to the SMVI group (2.5%; 4/163) (RR 4.05; CI 1.54-10.67). As for NYHA functional class ≥ III at 12 months, no significant differences were observed between the MTEER and SMVI groups (RR 0.81; CI 0.25-2.59).</span></span></span></span></p> <p><span style="font-size:12.0pt"><span style="font-family:"Aptos",sans-serif"><span style="color:black">To mitigate selection bias inherent to observational studies, only propensity-score matched cohorts were analyzed alongside RCTs. While no statistically significant differences in MV reinterventions were observed, SMVI was associated with fewer reinterventions overall. This may be partly due to the analysis focusing solely on MV reinterventions, without considering other surgery-related reinterventions in SMVI patients. Additionally, during the EVEREST trial, MTEER was a novel technique with limited experience, leading to higher failure rates, more reinterventions, and potentially higher recurrence of significant MR. The pooled population included both primary and secondary MR patients, and the use of different techniques across comparator groups added heterogeneity. This heterogeneity warrants caution in interpreting the results, as it may affect the robustness of the analysis.</span></span></span></p>
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