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Journal of Interventional Cardiology
Volume 2019, Article ID 2753146, 10 pages
https://doi.org/10.1155/2019/2753146
Research Article

Percutaneous Mitral Valve Repair versus Optimal Medical Therapy in Patients with Functional Mitral Regurgitation: A Systematic Review and Meta-Analysis

1Department of Internal Medicine, Raleigh General Hospital, West Virginia University, WV, USA
2Department of Internal Medicine, Civil Hospital, Dow University, Karachi, Pakistan
3Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL, USA
4Department of Internal Medicine, West Virginia University, WV, USA
5Division of Cardiology, Westchester Medical Center, Valhalla, NY, USA
6Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
7Division of Cardiology, West Virginia University, Morgantown, WV, USA

Correspondence should be addressed to Mohamad Alkhouli; gro.enicidemuvw@iluohkla.damahom

Received 6 December 2018; Revised 12 March 2019; Accepted 27 March 2019; Published 21 April 2019

Academic Editor: Joseph Dens

Copyright © 2019 Muhammad Uzair Lodhi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives. To compare percutaneous mitral valve repair (PMVR) with optimal medical therapy (OMT) in patients with heart failure (HF) and severe functional mitral regurgitation (FMR). Background. Many patients with HF and FMR are not suitable for surgical valve replacement and remain symptomatic despite maximal OMT. PMVR has recently emerged as an alternative solution. Methods. We performed a systematic review and a meta-analysis to address this question. Cochrane CENTRAL, MEDLINE, and Scopus were searched for randomized (RCT) and nonrandomized studies comparing PMVR with OMT in patients with HF and FMR. Primary endpoint was all-cause midterm mortality (at 1 and 2 years). Secondary endpoints were 30-day mortality and cardiovascular mortality and HF hospitalizations, at maximum follow-up. Studies including mixed cohort of degenerative and functional MR were allowed initially but were excluded in a secondary sensitivity analysis for each of the study’s end points. This meta-analysis was performed following the publication of two RCTs (MITRA-FR and COAPT). Results. Eight studies (six observational, two RCTs) comprising 3,009 patients were included in the meta-analysis. In comparison with OMT, PMVR significantly reduced 1-year mortality (RR: 0.70 [0.56, 0.87]; p=0.002; I2=47.6%), 2-year mortality (RR: 0.63 [0.55, 0.73]; p<0.001; I2=0%), and cardiovascular mortality (RR: 0.32 [0.23, 0.44]; p<0.001; I2=0%). No significant difference between PMVR+OMT and OMT was noted in HF hospitalization (HR: 0.69 [0.40, 1.20]; p=0.19; I2=85%) and 30-day mortality (RR: 1.13 [0.68, 1.87]; p=0.16; I2=0%). Conclusions. In comparison with OMT, PMVR significantly reduces 1-year mortality, 2-year mortality, and cardiovascular mortality in patients with HF and severe MR.