Transcatheter valve repair in functional mitral insufficiency: systematic review and meta-analysis

Paul E. Hernández-Montes, Departamento de Medicina General, Centro de Salud Juan Escutia; Unidad Académica de Medicina, Universidad Autónoma de Nayarit; Tepic, Nayarit, México
César J. Guitrón-Ramírez, Unidad Académica de Medicina, Universidad Autónoma de Nayarit; Departamento de Medicina, Hospital General de Subzona, Clínica 08, IMSS; Tepic, Nayarit, México
Miguel A. Flores-Solís, Unidad Académica de Medicina, Universidad Autónoma de Nayarit; Departamento de Medicina, Unidad de Medicina Familiar No. 02, IMSS; Tepic, Nayarit, México
María F. Martínez-Gutiérrez, Unidad Académica de Medicina, Universidad Autónoma de Nayarit; Departamento de Trasplante y Donación de Órganos, Hospital General de Zona No. 1, IMSS. Tepic, Nayarit, México
Lyan Z. Rivera-Caloca, Unidad Académica de Medicina, Universidad Autónoma de Nayarit, Tepic, Nayarit, México

A review is performed to evaluate the effectiveness of valve repair in patients with functional mitral regurgitation in terms of mortality and hospitalizations due to heart failure. Randomized clinical trials and cohort studies were included with patients who had moderate to severe mitral regurgitation, an ejection fraction of 20-50%, and NYHA functional class II-IV, despite receiving optimal medical therapy (OMT). Articles published between 2020 and 2025 in PubMed, Scopus, and Web of Science were reviewed. A total of 2,520 patients from seven studies were included. In 787 patients, the use of MitraClip was compared with mitral valve repair surgery, and no significant differences were observed in mortality (OR: 0.95; 95% CI: 0.64-1.35; p = 0.70) or hospitalizations due to heart failure (OR: 0.87; 95% CI: 0.87-1.33; p = 0.52). On the other hand, in 1,733 patients, MitraClip combined with OMT was compared to OMT alone. MitraClip combined with OMT showed a significant reduction in cardiovascular mortality (OR: 0.75; 95% CI: 0.61-0.92; p = 0.005) and in hospitalizations for heart failure (OR: 0.60; 95% CI: 0.49-0.74; p < 0.00001). MitraClip combined with OMT showed significant improvement in mortality and reduction in hospitalizations for heart failure compared to OMT alone, but no significant differences were found when compared to mitral valve repair surgery in terms of mortality and hospitalization.

Keywords: Mitral regurgitation. Heart failure. Mitral valve repair. Systematic review.