Journal article
Percutaneous Transcatheter Edge-to-Edge Repair for Functional Mitral Regurgitation in Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials With Reconstructed Time-to-Event Data
Catheterization and cardiovascular interventions, Vol.106(2), pp.1067-1077
08/2025
DOI: 10.1002/ccd.31629
PMID: 40452619
Abstract
Background Mitral transcatheter edge-to-edge repair (TEER) is approved for patients with severe functional mitral regurgitation (FMR) beyond optimal medical therapy (OMT). Aims We aimed to assess TEER's efficacy beyond OMT in patients with severe FMR. Methods A systematic review and meta-analysis were conducted, including randomized controlled trials from PubMed, Cochrane, Scopus, and EMBASE up to September 2024. Primary outcome: heart failure hospitalization (HFH); secondary outcomes: cardiovascular (CV) mortality, all-cause mortality, and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores. Time-to-event data from Kaplan-Meier curves were reconstructed for individual patient data. Results Three studies (1423 patients) were included. TEER significantly reduced HFH (RR 0.73, 95% CI 0.58-0.92, p < 0.01) and CV mortality (RR 0.79, 95% CI 0.66-0.95, p = 0.01), and improved KCCQ scores (mean difference 14.32, 95% CI 10.85-17.80, p < 0.01) compared to OMT. No significant difference was found for all-cause mortality (RR 0.80, 95% CI 0.63-1.02, p = 0.07). Prognostic meta-analysis showed a 34% reduced risk of HFH (HR 0.66, 95% CI 0.45-0.96, p = 0.03), but no effect on all-cause or CV mortality. Reconstructed Kaplan-Meier analysis confirmed a 34% reduced risk of HFH (HR 0.65, p < 0.001), with effect attenuation after 15 months in landmark analysis (HR 0.64, p = 0.07). RMST analysis showed a 2.9-month longer HFH-free survival with TEER (p < 0.01). Conclusion In patients with FMR, TEER significantly reduces HFH, improves functional status, and lowers CV mortality at 24 months but does not significantly affect all-cause mortality. The device group experienced a modest, but significant, 2.9-month longer HFH-free survival compared to the control group. However, the reduction in HFH showed attenuation beyond 15 months.
Details
- Title: Subtitle
- Percutaneous Transcatheter Edge-to-Edge Repair for Functional Mitral Regurgitation in Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials With Reconstructed Time-to-Event Data
- Creators
- Ramy Ghaly - University of Missouri–Kansas CityAhmed Mazen Amin - Mansoura UniversitySamuel Kim - University of Missouri–Kansas CityHosam I. Taha - Tanta UniversityMohamed S. Elgendy - Tanta UniversityAnan Abu Rmilah - Magnolia Reg Hlth Ctr, Internal Med Dept, Corinth, MS USAMohamed Abuelazm - Tanta UniversityMirza S. Khan - University of Missouri–Kansas City
- Resource Type
- Journal article
- Publication Details
- Catheterization and cardiovascular interventions, Vol.106(2), pp.1067-1077
- DOI
- 10.1002/ccd.31629
- PMID
- 40452619
- NLM abbreviation
- Catheter Cardiovasc Interv
- ISSN
- 1522-1946
- eISSN
- 1522-726X
- Publisher
- Wiley
- Number of pages
- 11
- Grant note
- The authors received no specific funding for this work.
- Language
- English
- Electronic publication date
- 06/02/2025
- Date published
- 08/2025
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984845398602771
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