这项系统评价和荟萃分析旨在研究使用MitraClip的经皮二尖瓣修复(PMVr)在长期发病率和死亡率方面是否比手术或药物治疗更有效。我们搜索了MEDLINE,EMBASE,和CENTRAL(CochraneLibrary)数据库,以确定相关研究,这些研究招募了功能性或继发性二尖瓣反流的成年患者,并使用适当的搜索词和布尔运算符进行了MitraClip植入PMVr。使用随机效应模型汇集比值比(OR)。共纳入14项招募2,593名患者的研究。在随访的12个月内,接受PMVr的患者未维持二尖瓣反流2级以上(OR0.22,95%置信区间[CI]0.12至0.41,p<0.0001,I2=0.0%,p=0.52)或无症状心力衰竭(OR0.47,95%CI0.29至0.77,p=0.0028,I2=0.0%,p=0.66)与外科手术相比。患者更有可能因心力衰竭再次住院(OR2.79,95%CI1.54至5.05,p=0.0007,I2=0.0%,p=0.51)。然而,在全因死亡率或心血管死亡率方面,两组间无差异.然而,与药物治疗相比,在随访12个月和≥24个月时,PMVr显着降低了全因死亡率(OR0.41,95%CI0.24,0.69,p=0.0009,I2=32%,p=0.23和OR0.55,95%CI0.40,0.75,p=0.0002,I2=0.0%,分别为p=0.45)。总之,在随访12个月或24个月时,PMVr和手术方法之间的全因死亡没有差异,但瓣膜修复的耐久性不如PMVr。与药物治疗相比,PMVr的死亡率显著降低.
This systematic review and meta-analysis aimed to investigate whether percutaneous mitral valve repair (PMVr) using MitraClip was more effective than surgery or medical therapy for long-term morbidity and mortality. We searched MEDLINE, EMBASE, and CENTRAL (Cochrane Library) databases to identify relevant studies that recruited adult patients with functional or secondary mitral valve regurgitation who underwent PMVr with MitraClip implantation using appropriate search terms and Boolean operators. The odds ratios (ORs) were pooled using the random-effects model. A total of 14 studies recruiting 2,593 patients were included. Within 12 months of follow-up, patients who underwent PMVr did not maintain mitral valve regurgitation grade 2+ (OR 0.22, 95% confidence interval [CI] 0.12 to 0.41, p <0.0001, I2 = 0.0%, p = 0.52) or symptom-free heart failure (OR 0.47, 95% CI 0.29 to 0.77, p = 0.0028, I2 = 0.0%, p = 0.66) compared with their surgical counterparts. Patients were more likely to be rehospitalized for heart failure (OR 2.79, 95% CI 1.54 to 5.05, p = 0.0007, I2 = 0.0%, p = 0.51). However, there was no difference between the groups in terms of all-cause or cardiovascular mortality. Whereas, in comparison with medical therapy, PMVr significantly reduced all-cause mortality at 12 and ≥24 months of follow-up (OR 0.41, 95% CI 0.24, 0.69, p = 0.0009, I2 = 32%, p = 0.23 and OR 0.55, 95% CI 0.40, 0.75, p = 0.0002, I2 = 0.0%, p = 0.45, respectively). In conclusion, there was no difference in all-cause death at 12 or 24 months of follow-up between PMVr and the surgical approach, but the durability of valvular repair was inferior with PMVr. In comparison with medical therapy, there was a significant reduction in mortality with PMVr.