Device Based Mitral Valve Repair vs. Medical Therapy for Functional Mitral Regurgitation: An updated Meta-analysis

Background:
Functional mitral regurgitation from left ventricular dilatation in patients with heart failure has been associated with frequent hospitalizations, decreased quality of life and increased mortality. Treatment is predominantly aimed at medical management with unclear benefit from surgical repair/replacement. Several studies have looked at outcomes from device based mitral valve repair with conflicting results. We conducted a meta-analysis of all studies comparing outcomes in functional mitral regurgitation with percutaneous mitral valve repair vs. medical therapy alone.

Methods:
We searched PubMed, Medline and Embase for relevant studies. Two RCT’s and Five observational studies that compared MitraClip to optimal medical therapy only for treatment of functional mitral regurgitation were included. Mantel- Haenszel random effects model was used to calculate odds ratio (OR) and 95% confidence intervals (CI). Outcomes analyzed were death from any cause and hospital readmission rates.

Results:
Our meta-analysis shows statistically significant mortality benefit in patients undergoing device based mitral valve repair compared to medical therapy alone {OR = 0.46 (0.29-0.73), p <0.05} and a statistically significant reduction in readmissions in the device closure group {OR=0.29 (0.11-0.72), p <0.05}.

Conclusions:
Device based mitral valve repair with MitraClip has mortality benefit and reduces risk of re-admissions as compared to medical therapy alone.