Outcomes of mitral valve transcatheter edge-to-edge repair for patients with hemodynamic instability: A systematic review and meta-analysis

Hiroaki Yokoyama; Tatsuya Kokawa; Saori Shigekiyo; Akiho Seno; Tomoko Izumi; Riyo Ogura; Keitaro Mahara; Shinobu Hosokawa

doi:10.1016/j.carrev.2024.04.006

Outcomes of mitral valve transcatheter edge-to-edge repair for patients with hemodynamic instability: A systematic review and meta-analysis

Cardiovasc Revasc Med. 2024 Apr 4:S1553-8389(24)00149-0. doi: 10.1016/j.carrev.2024.04.006. Online ahead of print.

Authors

Hiroaki Yokoyama¹, Tatsuya Kokawa², Saori Shigekiyo², Akiho Seno², Tomoko Izumi², Riyo Ogura², Keitaro Mahara², Shinobu Hosokawa²

Affiliations

¹ Tokushima Red Cross Hospital, Tokushima, Japan. Electronic address: hyokoyama1986@gmail.com.
² Tokushima Red Cross Hospital, Tokushima, Japan.

PMID: 38584083
DOI: 10.1016/j.carrev.2024.04.006

Abstract

Background: The outcomes after mitral valve transcatheter edge-to-edge repair (M-TEER) for the patients with severe mitral regurgitation (MR) in hemodynamically unstable conditions, such as cardiogenic shock, still remain unclear. We aimed to integrate previous publications regarding M-TEER indicated for life-threatening conditions and indirectly particularly compared the short-term outcomes thereof, with that of other treatments.

Methods: We systematically searched the PubMed, Cochrane, and MEDLINE databases for studies from inception to June 2023, regarding M-TEER in patients with hemodynamic instability and severe MR. The primary outcomes analyzed included the in-hospital and 30-day mortality rates, and peri-procedural complications.

Results: Of the initial 820 publications, we conducted a meta-analysis of a total of 25 studies. The relative risk of moderate-to-severe or severe MR was 0.13 (95 % confidence interval [CI]: 0.10-0.18, I² = 45.2 %). The pooled in-hospital and 30-day mortality rates were 11.8 % (95 % CI: 8.7-15.9, I² = 96.4 %) and 14.1 % (95 % CI: 10.9-18.3, I² = 35.5 %), respectively. The 30-day mortality rate was statistically significantly correlated with the residual moderate-to-severe or severe MR, as per the meta-regression analysis (coefficient β = 3.48 [95 % CI: 0.99-5.97], p = 0.006). Regarding peri-procedural complications, the pooled rates of a stroke or transient ischemic attack, life-threatening or major bleeding, acute kidney injury, and peri-procedural mitral valve surgery were 2.3 % (95 % CI: 1.9-2.6), 7.6 % (95 % CI: 6.8-8.5), 32.9 % (95 % CI: 31.6-34.3), and 1.0 % (95 % CI: 0.8-1.3), respectively.

Conclusions: This meta-analysis demonstrates that the relatively higher rates of procedural complications were observed, nevertheless, M-TEER can potentially provide favorable short-term outcomes even in hemodynamically unstable patients.

Prospero registration number: CRD42023468946.

Keywords: Acute myocardial infarction; Cardiogenic shock; Mechanical circulatory support device; Mitral regurgitation; Mitral valve transcatheter edge-to-edge repair.