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

Interventions for valvular disease and heart failure

Stroke after transcatheter edge-to-edge mitral valve repair: a systematic review and meta-analysis

EuroIntervention 2020;15:1401-1408. DOI: 10.4244/EIJ-D-19-00602

1. Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal; 2. Serviço de Documentação, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; 3. Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

Aims: The aim of this study was to assess the stroke rate after transcatheter mitral valve repair (TMVR) with the MitraClip, comparing it with surgical mitral valve repair (SMVR) and optimal medical treatment (OMT).

Methods and results: In December 2018, we systematically searched PubMed, Embase and Cochrane Controlled Register of Trials 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 1,881 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).  However, there was a trend towards a lower stroke risk in TMVR. 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: Despite both a low number of pooled stroke events and the failure to reach the pre-specified statistical significance, there was a trend for a lower post-procedure stroke rate in TMVR when compared with SMVR and a similar one between TMVR and OMT alone.

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