Percutaneous Mitral Valve Repair Versus Surgery in Patients With Mitral Regurgitation: A Meta-Analysis

While studies confirm the feasibility of percutaneous mitral valve repair, its short- and long-term outcomes compared with mitral valve surgery remain debated. This meta-analysis aims to evaluate the clinical outcomes with a percutaneous approach and surgery. A comprehensive literature search of major databases that included PubMed, Embase, and the Cochrane Library was performed from inception to November 2024. Randomized controlled trials (RCTs) and propensity-adjusted observational studies that reported clinical outcomes following percutaneous mitral valve repair versus mitral valve surgery in patients with mitral regurgitation were included in the review. The pooled estimates were calculated using a random effects model. A total of 6 studies (n = 5411 patients) were included. The pooled analysis demonstrated no statistically significant difference between the 2 approaches for all-cause death at 1 month [risk ratio (RR) = 1.13, 95% confidence interval (CI): 0.54-2.37], and 1 year (RR = 1.98, 95% CI: 0.91-4.32). The risk of stroke was significantly reduced in the percutaneous group (RR = 0.42, 95% CI: 0.23-0.74); however, the pooled estimates remained comparable for hospitalization for heart failure (RR = 0.88, 95% CI: 0.38-2.04), all-cause rehospitalization (RR = 1.03, 95% CI: 0.55-1.95), sepsis (RR = 0.25, 95% CI: 0.06-1.13), atrial fibrillation (RR = 0.44, 95% CI: 0.10-2.06), and Grade 3+ or 4+ mitral regurgitation (RR = 3.02, 95% CI: 0.74-12.37). Compared with surgery, the percutaneous approach demonstrates a similar safety profile and a reduced risk of stroke. However, long-term mortality is comparable between the 2 techniques, indicating that a patient-tailored approach will lead to optimal results.