Effects of Pharmacological and Surgical Treatments on Mitral Regurgitation Regression and Left Heart Structures: A Meta-Analysis

Abstract

Background: An integrated evaluation of medical therapy and surgical intervention for mitral regurgitation (MR) regression is necessary. Methods: Eligible studies in five electronic databases were screened by two independent reviewers. Relative risk (RR) was calculated for an echocardiographic MR grade ≤ 2+, and the standard mean difference (SMD) was calculated for the percentage change in MR severity and left ventricular/atrial volume with random-effects models. Results: A total of 24 RCTs including 3711 patients were collected. Overall medical therapy decreased MR area (SMD = −1.13) and volume (SMD = −0.76), whereas angiotensin receptor and neprilysin inhibitors (SMD = −0.49) and sodium glucose cotransporter-2 inhibitors (SMD = −0.70) had better performance, on the basis of decreased left atrial volume. Transcatheter mitral valve repair (TMVr) performed similarly to mitral valve surgery (MVS) (RR = 0.99) but better than nonsurgical controls (RR = 3.02), according to 12-month MR grade ≤ 2+. The addition of MVS to coronary artery bypass grafting was associated with more ≤ 2+ MR (RR = 1.66) and lower left ventricular volume (SMD = −0.49) (all P < 0.05). A network meta-analysis supported the 12-month benefits of TMVr and MVS for nonrecurrent MR. Conclusion: TMVr and MVS were associated with nonrecurrent MR, and medical therapy also decreased MR. The combination of medication and surgery might potentially be beneficial to reduce left heart size and to preserve its output.

Keywords

mitral regurgitation / left heart structure / medical therapy / mitral valve surgery / transcatheter mitral valve repair / network meta-analysis

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