MitraClip Versus Surgery for Secondary Mitral Regurgitation: A Systematic Review and Updated Meta-Analysis

The optimal management of secondary mitral regurgitation (MR) remains uncertain, with surgical and percutaneous approaches offering alternative treatment strategies.

To compare percutaneous repair with mitral transcatheter edge-to-edge repair (M-TEER) using MitraClip and surgical intervention in patients with secondary MR.

We systematically searched PubMed, Embase, and Cochrane for studies comparing M-TEER using MitraClip with surgery in secondary MR, reporting outcomes of interest. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random-effects model in R software. Heterogeneity was assessed with I² statistics.

A total of 11 studies (two randomized controlled trials and nine observational studies) comprising 1605 patients were included. The mean age was 69 years. Among them, 906 (57.7%) underwent MitraClip. Mean follow-up was 24.7 months (minimum: 6 months). The rate of MR grade ≤ 2+ at follow-up was lower in the MitraClip group compared to surgery (RR: 0.86, 95% CI: 0.78 to 0.95, p < 0.01). No significant differences were observed in all-cause mortality (RR: 1.18, 95% CI: 0.93 to 1.49, p = 0.16), cardiovascular mortality (RR: 1.42, 95% CI: 0.54 to 3.68, p = 0.47), heart failure hospitalizations (RR: 1.55, 95% CI: 0.79 to 3.04, p = 0.20), or NYHA class I/II at follow-up (RR: 0.92, 95% CI: 0.83 to 1.01, p = 0.08).

Although patients undergoing MitraClip exhibited a lower rate of residual MR ≤ 2+ at follow-up compared to those treated surgically, this did not translate into higher rates of clinical outcomes, including all-cause mortality, cardiovascular mortality, heart failure hospitalizations, or impaired functional status (NYHA classification).