A Meta-Analysis Of MitraClip System Versus Surgery For Treatment Of Mitral Regurgitation

Objectives:To assess the efficacy and safety of MitraClip contrast with surgery in treatment of mitral regurgitation.Methods:The Pubmed, Embase, Cochrane library, CNKI, VIP and Wang Fang were electronically searched from inception to November 2015 for all the Randomized Controlled Trial and cohort study with MitraClip and surgical treatment of mitral regurgitation. We also manual search related journals and tracked the related references. Odds ratios (OR) and 95% confidence intervals (95%CI) were employed to assess the efficacy and safety of MitraClip contrast with surgery in treatment of mitral regurgitation.Results:A total of seven elected studies involving 1015 patients were included. At baseline, patients in the MitraClip group were significantly older (P=0.000), had significantly higher Logistic EuroSCORE (P=0.004), higher MR≥3+rate (P=0.028), higher Previous cardiac surgery rate (P=0.002) and significantly lower LVEF (P=0.011). Meta-analysis showed that:there was no statistically significant difference in the30 day mortality (OR=0.631,95%CI: 0.255～1.558,P=0.318),1-year survival rates (OR=0.510,95%CI: 0.101～2.57.P=0.416), acute kidney injury events (OR=0.646,95%CI: 0.227～1.835, P=0.412), neurological events (OR=0.456,95%CI:0.157～1.327, P=0.15) and 1-year NYHA Class Ⅲ/Ⅳ(OR=0.510,95%CI:0.101～2.577, P= 0.416); and the blood transfusion events (OR=0.189,95%CI:0.111～0.320, P=0.000) were significantly lower in the MitraClip group compared to the surgical group, as well as the number of patients with post-procedure residual MR severity≤2+(OR=0.054,95%CI:0.018-0.168, P=0.000)Conclusion:Despite a higher risk profile in the MitraClip patients compared to surgical intervention, the clinical outcomes were similar in 30 day mortality, acute kidney injury events, neurological events,1-year survival rates and 1-year NYHA Class Ⅲ/Ⅳ. The effect of patients with post-procedure residual MR severity≤2+and the blood transfusion events were significantly lower in the MitraClip group compared to the surgical group.