Abstract：
Previous research indicates varying stroke rates after mitral valve (MV) interventions. This study aimed to compare postprocedural stroke risks after transcatheter and surgical MV interventions. Electronic databases were searched from inception to February 2024 for studies comparing stroke rates after mitral transcatheter edge-to-edge repair (mTEER), surgical MV repair/replacement, or guideline-directed medical therapy (GDMT). Primary end points were all-time and early (<30 days) stroke. Secondary outcomes included new-onset atrial fibrillation and 1-year all-cause mortality. A frequentist network meta-analysis was employed to compare outcomes. The network meta-analysis included 18 studies (3 randomized controlled trials and 15 observational), with 51,703 patients. mTEER was associated with a decreased risk of all-time (odds ratio [OR] 0.61, 95% confidence interval [CI] 0.41 to 0.89) and early stroke (OR 0.41, 95% CI 0.33 to 0.51) compared with surgery, and a similar risk of all-time (OR 1.54, 95% CI 0.76 to 3.12) and early stroke (OR 2.12, 95% CI 0.53 to 8.47) compared with GDMT. Conversely, surgery was associated with an increased risk of all-time (OR 2.55, 95% CI 1.17 to 5.57) and early stroke (OR 5.15, 95% CI 1.27 to 20.84) compared with GDMT. There were no statistically significant differences in the risk of new-onset atrial fibrillation (OR 0.38, 95% CI 0.11 to 1.31) and 1-year all-cause mortality (OR 1.43, 95% CI 0.91 to 2.24) between mTEER versus surgery. In conclusion, mTEER was associated with a lower risk of stroke and similar risks of new-onset atrial fibrillation and 1-year mortality compared with surgical MV interventions. Further studies are needed to understand the mechanisms of stroke and to determine strategies to reduce stroke risk after MV interventions.
摘要：
先前的研究表明，二尖瓣（MV）干预后中风率不同。本研究旨在比较经导管和手术MV干预后的术后卒中风险。从开始到2024年2月搜索电子数据库，以比较经二尖瓣导管边缘到边缘修复（mTEER）后的中风率。外科MV修复/更换，或指导医学治疗（GDMT）。主要终点是所有时间和早期（<30天）卒中。次要结局包括新发房颤和1年全因死亡率。采用频繁的网络荟萃分析来比较结果。网络荟萃分析包括18项研究（3项随机临床试验和15项观察性研究），51,703名患者。与手术相比，mTEER与所有时间（比值比[OR]0.61，95％CI0.41-0.89）和早期卒中（OR0.41，95％CI0.33-0.51）的风险降低相关，与GDMT相比，所有时间（OR1.54，95％CI0.76-3.12）和早期卒中（OR2.12，95％CI0.53-8.47）的风险相似。相反，与GDMT相比,手术与所有时间卒中(OR2.55,95%CI1.17-5.57)和早期卒中(OR5.15,95%CI1.27-20.84)的风险增加相关.mTEER与新发房颤的风险（OR0.38，95％CI0.11-1.31）和1年全因死亡率（OR1.43，95％CI0.91-2.24）之间无统计学差异。手术。总之,与手术MV干预相比,mTEER与较低的卒中风险和类似的新发房颤风险以及1年死亡率相关.需要进一步的研究来了解中风的机制，并确定降低MV干预后中风风险的策略。
