Abstract
Background: Secondary mitral regurgitation (SMR) is a frequent complication of heart failure, associated with high morbidity and mortality. While surgery is the standard for primary MR, many SMR patients are poor surgical candidates. Transcatheter mitral valve repair (TMVr) using the MitraClip offers a less invasive alternative, but its comparative efficacy and safety remain under active investigation and controversial. Methods: A systematic search of MEDLINE®, Embase®, and the Cochrane Library was conducted per PRISMA guidelines (PROSPERO ID: CRD420251016943). Eligible studies were randomized controlled trials (RCTs) comparing TMVr (MitraClip) with guideline-directed medical therapy (GDMT) or surgical repair in adult patients with SMR. Outcomes assessed included MR severity reduction, functional improvement (NYHA class), quality of life, heart failure hospitalizations, mortality, and procedural safety. Risk of bias was evaluated using the Cochrane RoB tool. Results: Nineteen RCTs comprising over 6,500 patients were included. TMVr consistently reduced MR severity to ≤2+ in 85–95% of patients and significantly improved NYHA functional class and quality of life (KCCQ score increase of 21.6 points in RESHAPE-HF2). TMVr also reduced heart failure hospitalizations and demonstrated a survival benefit in selected trials (COAPT, RESHAPE-HF2). Procedural success rates exceeded 96%, with low incidence of device-related complications or adverse events. Conclusion: TMVr with MitraClip provides effective and safe MR reduction in appropriately selected SMR patients. It improves symptoms, quality of life, and clinical outcomes, particularly in patients unsuitable for surgery. Patient selection remains key to optimizing benefit. These findings support the integration of TMVr into treatment algorithms for advanced heart failure with SMR.
Recommended Citation
Younas, Salma; Rana, Aditya; Ali Beig, Mirza Faizan; Sahu, Sweta; Emanemua, Cynthia Esohe; Reshie, Aisha Ashiq; Kaukab, Lamees; Duggineni, Dileep; Gokavarapu, S K S S P Ashish; Bhavani, Padamati; Khan, Afrasayab; and Fattal, Peter G.
(2025)
"Efficacy and Safety of Transcatheter Mitral Valve Repair (MitraClip) Compared to Medical Therapy and Surgery in Patients with Secondary Mitral Regurgitation: A Systematic Review & Pairwise Meta-Analysis,"
Journal of the Saudi Heart Association: Vol. 37
:
Iss.
4
, Article 16.
Available at: https://doi.org/10.37616/2212-5043.1467
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