Functional mitral valve regurgitation outcomes by treatment modality: a systematic review and meta-analysis of reconstructed survival data.

BACKGROUND

Functional mitral regurgitation (FMR) carries poor prognosis, and optimal management remains debated. Mitral Transcatheter Edge-to-Edge Repair (MTEER) is an alternative to surgical repair (SMVR) or optimized medical therapy (OMT), but long-term outcomes are uncertain.

METHODS

PubMed, Embase, Scopus, and the Cochrane Library were searched for studies reporting Kaplan-Meier curves of MTEER, SMVR, or OMT in FMR. Individual patient data (IPD) were reconstructed using the Liu method with accuracy checks. Pooled IPD were analyzed with Cox and time-varying Cox models, landmark, time-restricted, and restricted mean survival time analyses.

RESULTS

Sixteen studies (n = 4,570) were included. Patients undergoing MTEER were older and higher risk, with greater prevalence of atrial fibrillation, prior myocardial infarction, chronic kidney disease, higher EuroSCORE, and more frequent NYHA class ≥ III compared with SMVR. Over up to 60 months, both MTEER (HR: 0.65; 95% CI: 0.57-0.75; p < 0.001) and SMVR (HR: 0.39; 95% CI: 0.33-0.46; p < 0.001) significantly reduced all-cause mortality versus OMT, whereas MTEER carried higher mortality risk than SMVR (HR: 1.68; 95% CI: 1.43-1.97; p < 0.001). MTEER was less effective than SMVR in reducing recurrent MR > 2 (HR: 3.31; 95% CI: 1.62-6.75; p < 0.001) and reoperation (HR: 4.62; 95% CI: 2.22-9.61; p < 0.001). In contrast, MTEER reduced hospitalization risk by 30% compared to OMT (HR: 0.70; 95% CI: 0.64-0.77; p < 0.001) and decreased MACE by 21% (HR: 0.79; 95% CI: 0.73-0.84; p < 0.001).

CONCLUSIONS

MTEER improves survival and reduces hospitalization and MACE compared with OMT but is less durable than SMVR, with higher risks of recurrent MR, reoperation, and late mortality.