Mitral Transcatheter Edge-to-Edge Repair Versus Guideline-Directed Medical Therapy for Functional Mitral Regurgitation With Heart Failure: An Updated Meta-analysis

Background Mitral transcatheter edge-to-edge repair (MTEER) and guideline-directed medical therapy (GDMT) may be used to treat functional mitral regurgitation (FMR) with heart failure (HF). The optimal management of FMR is unclear. Methods We performed a contemporary systematic review and meta-analysis comparing MTEER vs GDMT. PubMed, Embase, and Cochrane Central were systematically searched for randomized controlled trials and propensity score matched studies comparing outcomes of MTEER plus GDMT vs GDMT alone in FMR with HF. Odds ratios and risk ratios (RRs) with 95% CI were estimated using random-effects models. Results Three randomized controlled trials and 5 propensity score matched studies were identified (n = 2588) comparing MTEER (52.2%) vs GDMT alone (47.8%) for FMR with HF. MTEER was associated with lower risks of 12-month all-cause mortality (RR, 0.74; 95% CI, 0.58-0.95; P = .02), cardiovascular mortality (RR, 0.59; 95% CI, 0.38-0.93; P = .02), and HF hospitalization (RR, 0.64; 95% CI, 0.48-0.86; P < .001) compared with GDMT alone. Additionally, the MTEER group was more likely to achieve New York Heart Association class I/II at 12 months (odds ratio, 2.11; 95% CI, 1.48-2.99; P < .01) than the GDMT group. In contrast, the GDMT group had a significantly lower risk of mitral regurgitation recurrence than the MTEER group (RR, 2.20; 95% CI, 1.79-2.71; P < .01). There was no statistically significant difference in the risk of myocardial infarction or stroke between the groups. Conclusion MTEER reduced all-cause cardiovascular mortality and HF hospitalization in patients with FMR and HF compared with GDMT alone. Additionally, MTEER resulted in a significant improvement in functional status in these patients.