Abstract：
BACKGROUND: The outcomes after mitral valve transcatheter edge-to-edge repair (M-TEER) for the patients with severe mitral regurgitation (MR) in hemodynamically unstable conditions, such as cardiogenic shock, still remain unclear. We aimed to integrate previous publications regarding M-TEER indicated for life-threatening conditions and indirectly particularly compared the short-term outcomes thereof, with that of other treatments.
METHODS: We systematically searched the PubMed, Cochrane, and MEDLINE databases for studies from inception to June 2023, regarding M-TEER in patients with hemodynamic instability and severe MR. The primary outcomes analyzed included the in-hospital and 30-day mortality rates, and peri-procedural complications.
RESULTS: Of the initial 820 publications, we conducted a meta-analysis of a total of 25 studies. The relative risk of moderate-to-severe or severe MR was 0.13 (95 % confidence interval [CI]: 0.10-0.18, I2 = 45.2 %). The pooled in-hospital and 30-day mortality rates were 11.8 % (95 % CI: 8.7-15.9, I2 = 96.4 %) and 14.1 % (95 % CI: 10.9-18.3, I2 = 35.5 %), respectively. The 30-day mortality rate was statistically significantly correlated with the residual moderate-to-severe or severe MR, as per the meta-regression analysis (coefficient β = 3.48 [95 % CI: 0.99-5.97], p = 0.006). Regarding peri-procedural complications, the pooled rates of a stroke or transient ischemic attack, life-threatening or major bleeding, acute kidney injury, and peri-procedural mitral valve surgery were 2.3 % (95 % CI: 1.9-2.6), 7.6 % (95 % CI: 6.8-8.5), 32.9 % (95 % CI: 31.6-34.3), and 1.0 % (95 % CI: 0.8-1.3), respectively.
CONCLUSIONS: This meta-analysis demonstrates that the relatively higher rates of procedural complications were observed, nevertheless, M-TEER can potentially provide favorable short-term outcomes even in hemodynamically unstable patients.
UNASSIGNED: CRD42023468946.
METHODS: We systematically searched the PubMed, Cochrane, and MEDLINE databases for studies from inception to June 2023, regarding M-TEER in patients with hemodynamic instability and severe MR. The primary outcomes analyzed included the in-hospital and 30-day mortality rates, and peri-procedural complications.
RESULTS: Of the initial 820 publications, we conducted a meta-analysis of a total of 25 studies. The relative risk of moderate-to-severe or severe MR was 0.13 (95 % confidence interval [CI]: 0.10-0.18, I2 = 45.2 %). The pooled in-hospital and 30-day mortality rates were 11.8 % (95 % CI: 8.7-15.9, I2 = 96.4 %) and 14.1 % (95 % CI: 10.9-18.3, I2 = 35.5 %), respectively. The 30-day mortality rate was statistically significantly correlated with the residual moderate-to-severe or severe MR, as per the meta-regression analysis (coefficient β = 3.48 [95 % CI: 0.99-5.97], p = 0.006). Regarding peri-procedural complications, the pooled rates of a stroke or transient ischemic attack, life-threatening or major bleeding, acute kidney injury, and peri-procedural mitral valve surgery were 2.3 % (95 % CI: 1.9-2.6), 7.6 % (95 % CI: 6.8-8.5), 32.9 % (95 % CI: 31.6-34.3), and 1.0 % (95 % CI: 0.8-1.3), respectively.
CONCLUSIONS: This meta-analysis demonstrates that the relatively higher rates of procedural complications were observed, nevertheless, M-TEER can potentially provide favorable short-term outcomes even in hemodynamically unstable patients.
UNASSIGNED: CRD42023468946.
摘要：
背景：严重二尖瓣反流（MR）患者在血流动力学不稳定的情况下，经二尖瓣导管边缘到边缘修复（M-TEER）后的结果，比如心源性休克,仍然不清楚。我们旨在整合以前关于M-TEER的出版物，特别是间接比较其短期结果，与其他治疗方法一样。
方法：我们系统地搜索了PubMed，科克伦,和MEDLINE数据库从开始到2023年6月的研究，关于血液动力学不稳定和严重MR患者的M-TEER。分析的主要结果包括住院和30天死亡率，和围手术期并发症。
结果：在最初的820种出版物中，我们对总共25项研究进行了荟萃分析.中度至重度或重度MR的相对风险为0.13（95％置信区间[CI]：0.10-0.18，I2=45.2％）。合并的住院死亡率和30天死亡率分别为11.8％（95％CI：8.7-15.9，I2=96.4％）和14.1％（95％CI：10.9-18.3，I2=35.5％），分别。30天死亡率与残余中度至重度或重度MR有统计学显著相关,根据荟萃回归分析(系数β=3.48[95%CI：0.99-5.97]，p=0.006)。关于围手术期并发症，中风或短暂性脑缺血发作的合并发生率，危及生命或大出血，急性肾损伤，围手术期二尖瓣手术率为2.3%(95%CI:1.9-2.6)，7.6%（95%CI：6.8-8.5），32.9%（95%CI：31.6-34.3），和1.0%（95%CI：0.8-1.3），分别。
结论：这项荟萃分析表明，手术并发症的发生率相对较高，然而，即使在血流动力学不稳定的患者中，M-TEER也可能提供良好的短期结果。
■CRD42023468946。
方法：我们系统地搜索了PubMed，科克伦,和MEDLINE数据库从开始到2023年6月的研究，关于血液动力学不稳定和严重MR患者的M-TEER。分析的主要结果包括住院和30天死亡率，和围手术期并发症。
结果：在最初的820种出版物中，我们对总共25项研究进行了荟萃分析.中度至重度或重度MR的相对风险为0.13（95％置信区间[CI]：0.10-0.18，I2=45.2％）。合并的住院死亡率和30天死亡率分别为11.8％（95％CI：8.7-15.9，I2=96.4％）和14.1％（95％CI：10.9-18.3，I2=35.5％），分别。30天死亡率与残余中度至重度或重度MR有统计学显著相关,根据荟萃回归分析(系数β=3.48[95%CI：0.99-5.97]，p=0.006)。关于围手术期并发症，中风或短暂性脑缺血发作的合并发生率，危及生命或大出血，急性肾损伤，围手术期二尖瓣手术率为2.3%(95%CI:1.9-2.6)，7.6%（95%CI：6.8-8.5），32.9%（95%CI：31.6-34.3），和1.0%（95%CI：0.8-1.3），分别。
结论：这项荟萃分析表明，手术并发症的发生率相对较高，然而，即使在血流动力学不稳定的患者中，M-TEER也可能提供良好的短期结果。
■CRD42023468946。
