The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Stroke after MitraClip:Systematic Review and Meta-Analysis

DOI: 10.4244/EIJ-D-19-00602

1. Universidade de Coimbra Faculdade de Medicina, Cardiology, Coimbra, Portugal
2. Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
3. Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal; Serviço de Documentação, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
4. Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
5. Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal; Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
6. Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal; Sevico de Cardiological, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal, Portugal
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Aims: To assess stroke rate after transcatheter mitral valve repair (TMVR) with MitraClip, comparing it with surgical mitral valve repair (SMVR) and optimal medical treatment (OMT). 

Methods and results: We systematically searched PubMed, Embase and Cochrane Controlled Register of Trials, in December 2018, for studies comparing TMVR with SMVR and/or OMT for the treatment of severe mitral regurgitation. Random‐effects and cumulative meta-analysis was performed. Ten studies were included: seven of TMVR versus SMVR and three of TMVR versus OMT, providing a total of 1881 patients and 61 pooled strokes (16 in TMVR versus SMVR and 45 in TMVR versus OMT). There was no difference in stroke incidence between TMVR and SMVR (pooled OR 0.49 [0.17, 1.42], P=0.19). Cumulative meta-analysis showed a significantly lower stroke rate in TMVR, compared to SMVR (OR 0.4 [0.24, 0.67], P< 0.01). For TMVR versus OMT, no difference in stroke rate was identified (pooled OR 1.09 [0.60, 1.97], P=0.79). Post-procedure de novo atrial fibrillation was more frequent in SMVR when compared with TMVR. 

Conclusions:Although with a low number of pooled events, there was a trend for a lower post-procedure stroke in TMVR when compared with SMVR and a similar one between TMVR and OMT alone.

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