Sasmita Bryan Richard, Luo Suxin, Huang Bi
Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, China.
Rev Cardiovasc Med. 2024 Jan 29;25(2):48. doi: 10.31083/j.rcm2502048. eCollection 2024 Feb.
Ventricular functional mitral regurgitation (FMR) is a common morbidity in patients with heart failure (HF). In addition to guideline-directed medical therapy, mitral valve (MV) repair or replacement has become an option for such patients. However, the impact of different treatments on cardiac remodeling, function, and clinical outcomes remains unclear.
We systematically searched PubMed, EMBASE, Medline, Clinical Trials.gov, and the Cochrane Central Register of Controlled Trials with search terms related to mitral regurgitation, mitral valve repair, surgical mitral valve replacement, mitral annuloplasty device, and MitraClip. The outcomes were left ventricular ejection fraction (LVEF), left ventricular (LV) remodeling, all-cause mortality, cardiovascular death, and HF hospitalization. Sensitivity analysis was performed by removing high-bias risk studies. The analysis was done by Review Manager 5.4 Analyzer and MedCalc Statistical Software version 19.2.6.
This meta-analysis included 10 studies with a total of 2533 patients (567 with transcatheter MitraClip, 823 with surgical MV repair, 651 with surgical MV replacement, and 492 with medical therapy). Our meta-analysis revealed that surgical MV repair had significant improvement in LVEF compared to the surgical MV replacement (mean differences (MD) 2.32, [95% CI 0.39, 4.25]), while transcatheter MitraClip treatment was associated with LVEF reduction (MD -4.82, [95% CI -7.29, -2.34]). In terms of LV remodeling, transcatheter MitraClip treatment was associated with improvement in left ventricular end-diastolic volume (MD -10.36, [95% CI -18.74, -1.99]). Furthermore, compared to surgical MV replacement, surgical MV repair was not associated with a reduction of all-cause mortality (risk ratio (RR) 0.83, [95% CI 0.61, 1.13]) and cardiovascular death (RR 0.95, [95% CI 0.56, 1.62]), while transcatheter MitraClip was associated with reduced risk of all-cause mortality (RR 0.87, [95% CI 0.78, 0.98]).
Surgical MV repair was associated with significant improvement in LVEF but had no significant effect on all-cause mortality compared to surgical MV replacement. Transcatheter MitraClip was associated with better long-term survival than the non-MitraClip group, thus, transcatheter MitraClip could be considered an alternative treatment in patients with HF-complicated ventricular FMR.
心室功能性二尖瓣反流（FMR）是心力衰竭（HF）患者的常见病症。除了指南指导的药物治疗外，二尖瓣（MV）修复或置换已成为此类患者的一种选择。然而，不同治疗方法对心脏重塑、功能和临床结局的影响仍不明确。
我们系统检索了PubMed、EMBASE、Medline、ClinicalTrials.gov和Cochrane对照试验中央注册库，检索词与二尖瓣反流、二尖瓣修复、外科二尖瓣置换、二尖瓣环成形术装置和MitraClip相关。结局指标为左心室射血分数（LVEF）、左心室（LV）重塑、全因死亡率、心血管死亡和HF住院率。通过剔除高偏倚风险研究进行敏感性分析。分析使用Review Manager 5.4分析器和MedCalc统计软件版本19.2.6。
这项荟萃分析纳入了10项研究，共2533例患者（567例接受经导管MitraClip治疗，823例接受外科MV修复，651例接受外科MV置换，492例接受药物治疗）。我们的荟萃分析显示，与外科MV置换相比，外科MV修复使LVEF有显著改善（平均差值（MD）2.32，[95%置信区间0.39，4.25]），而经导管MitraClip治疗与LVEF降低相关（MD -4.82，[95%置信区间-7.29，-2.34]）。在LV重塑方面，经导管MitraClip治疗与左心室舒张末期容积改善相关（MD -10.36，[95%置信区间-18.74，-1.99]）。此外，与外科MV置换相比，外科MV修复与全因死亡率降低（风险比（RR）0.83，[95%置信区间0.61，1.13]）和心血管死亡降低（RR 0.95，[95%置信区间0.56，1.62]）无关，而经导管MitraClip与全因死亡率风险降低相关（RR 0.87，[95%置信区间0.78，0.98]）。
与外科MV置换相比，外科MV修复使LVEF有显著改善，但对全因死亡率无显著影响。经导管MitraClip与非MitraClip组相比具有更好的长期生存率，因此，经导管MitraClip可被视为HF合并心室FMR患者的一种替代治疗方法。
