Abstract 20220: Comparison of MitraClip vs Conservative Management for Inoperable Functional Mitral Regurgitation
Background: Transcatheter edge-to-edge mitral valve repair with the use of the MitraClip device has proven to be safe and effective for patients with inoperable severe symptomatic primary mitral regurgitation. Its use in functional mitral regurgitation (FMR) remains controversial.
Hypothesis: MitraClip is feasible and improves mortality when compared to optimal medical therapy (OMT) alone for patients with inoperable severe symptomatic FMR.
Methods: We searched MEDLINE, EMBASE, and Cochrane Library through June 2016 for prospective studies comparing the use of MitraClip vs. OMT alone. Only studies with FMR etiology found in > 75% of patients were included in the analysis. Outcomes were compared under the random-effects model and heterogeneity examined via Chi2 and I2 statistics. RevMan 5.3 was used for statistical analysis.
Results: A total of 3 studies including 796 patients with inoperable severe symptomatic mitral regurgitation (age 74 ± 10 years, 60% men, 87% FMR, NYHA II-IV) managed with MitraClip (n=438) or OMT (n=358) were included in the analysis. Procedural success was high (86%) in the MitraClip group. Thirty-day overall mortality was comparable for MitraClip and OMT (OR 0.55; 95% CI 0.25 to 1.20; p=0.13). Twelve-month overall mortality was found to be significantly reduced with MitraClip compared to OMT (OR 0.48; 95% CI 0.34 to 0.66; p<0.001). Additionally, 12-month cardiovascular mortality was also decreased with the use of MitraClip (OR 0.13; 95% CI 0.07 to 0.24; p<0.001).
Conclusion: Our pooled analysis suggests that MitraClip is not only feasible, but also improves mortality at 12-months when compared to OMT alone for patients with inoperable FMR. Larger randomized trials in patients with severe symptomatic FMR are needed to confirm these findings. The ongoing COAPT trial will most likely shed further light on this topic.
Author Disclosures: V. Blumer: None. R. Mendirichaga: None. M. Rivera: None. V. Singh: None. A. Rodriguez: None. C.E. Alfonso: None. M.G. Cohen: None. E. De Marchena: None.
- © 2016 by American Heart Association, Inc.