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Heart. 2018 Feb;104(4):306-312. doi: 10.1136/heartjnl-2017-311412. Epub 2017 Jun 29.

Outcome after percutaneous edge-to-edge mitral repair for functional and degenerative mitral regurgitation: a systematic review and meta-analysis.

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Interventional Cardiology Unit, Humanitas Clinical and Research Center, Rozzano, Italy.
Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Cardiology, NIHR Biomedical Research Unit, Royal Brompton Hospital, London, UK.
Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Roma, and Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Latina, Italy.
Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
Universitäts Spital Zurich, University Heart Center, Zurich, Switzerland.
NorthShore University HealthSystem, Evanston, Illinois.
Cardiac Surgery Unit, San Raffaele Hospital, Milan, Italy.



Differences in terms of safety and efficacy of percutaneous edge-to-edge mitral repair between patients with functional and degenerative mitral regurgitation (MR) are not well established. We performed a systematic review and meta-analysis to clarify these differences.


PubMed, EMBASE, Google scholar database and international meeting abstracts were searched for all studies about MitraClip. Studies with <25 patients or where 1-year results were not delineated between MR aetiology were excluded. This study is registered with PROSPERO.


A total of nine studies investigating the mid-term outcome of percutaneous edge-to-edge repair in patients with functional versus degenerative MR were included in the meta-analysis (n=2615). At 1 year, there were not significant differences among groups in terms of patients with MR grade≤2 (719/1304 vs 295/504; 58% vs 54%; risk ratio (RR) 1.12; 95% CI: 0.86 to 1.47; p=0.40), while there was a significantly lower rate of mitral valve re-intervention in patients with functional MR compared with those with degenerative MR (77/1770 vs 80/818; 4% vs 10%; RR 0.60; 95% CI: 0.38 to 0.97; p=0.04). One-year mortality rate was 16% (408/2498) and similar among groups (RR 1.26; 95% CI: 0.90 to 1.77; p=0.18). Functional MR group showed significantly higher percentage of patients in New York Heart Association class III/IV (234/1480 vs 49/583; 16% vs 8%; p<0.01) and re-hospitalisation for heart failure (137/605 vs 31/220; 23% vs 14%; p=0.03). No differences were found in terms of single leaflet device attachment (25/969 vs 20/464; 3% vs 4%; p=0.81) and device embolisation (no events reported in both groups) at 1 year.


This meta-analysis suggests that percutaneous edge-to-edge repair is likely to be an efficacious and safe option in patients with both functional and degenerative MR. Large, randomised studies are ongoing and awaited to fully assess the clinical impact of the procedure in these two different MR aetiologies.


degenerative mitral regurgitation; functional mitral regurgitation; meta-analysis; percutaneous edge-to-edge repair

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Conflict of interest statement

Competing interests: FM has received consulting fees from Abbott Vascular, Medtronic, ValtechCardio, and St. Jude Medical; is a founder of 4Tech; and has received royalties from Edwards Lifesciences. TF has received consulting fees and research support from Abbott, Boston Scientific, Edwards and WL Gore. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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