Mitral Transcatheter edge-to-edge repair rivals surgery for survival despite less complete correction: a systematic review and metanalysis of randomized and propensity score matching studies

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Abstract Aims To compare outcomes of patients with severe mitral regurgitation (MR) after m-TEER and surgery. Methods and results PubMed, Scopus, and Google Scholar databases were searched for randomized controlled trials and propensity score matching studies comparing mid-term outcomes of m-TEER vs. surgical valve repair. All-cause of death, rehospitalization for heart failure, mitral reintervention, NYHA class at clinical follow-up and grade ≥ 3 at echocardiographic follow-up were the outcomes of interest. Additional sensitivity analyses were performed to account for heterogeneity. Nine studies (2 RCT and 7 propensity score matching studies) with a total of 23 825 patients (m-TEER group = 11 970; surgery group = 11 855) were included. Surgery and m-TEER were associated with comparable rates of all-cause mortality at a median follow-up of 18 months (RR 1.02, 95%CI 0.77–1.37, P-value 0.87). Surgical repair was associated with a reduced risk of rehospitalization for heart failure (RR 1.70, 95%CI 1.47–1.98, P value < 0.01) and mitral reintervention (RR 3.27, 95%CI 2.49–4.30, P value < 0.01), due to a reduced at least moderate residual MR (RR 6.35, 95%CI 1.43–28.22, P value 0.02). Conclusion In patients with severe MR, m-TEER resulted in comparable outcomes for all-cause deaths compared to surgery, although the latter was associated with reductions in heart failure rehospitalization, reintervention and MR residual rates at a median 18-month follow-up.

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