Outcomes of Transcatheter Mitral Valve Repair Using the MitraClip System in Patients With Atrial Fibrillation. A Meta-Analysis

Abstract

Transcatheter mitral valve repair (TMVR) with the MitraClip system is now approved for degenerative and functional mitral regurgitation (MR). Atrial fibrillation (AF) is commonly seen in MR. In our study, we perform a pooled analysis of the existing data to investigate the outcomes of MitraClip in patients with vs without AF. We conducted a systematic search of PubMed, Google Scholar, and SCOPUS databases through December, 2022 for studies comparing the outcomes of TMVR using the MitraClip in patients with pre-existing AF vs without AF. A meta-analysis was performed to investigate the primary outcomes of all-cause mortality and HF hospitalization. Secondary outcomes were cardiovascular mortality, in-hospital mortality, stroke, New York Heart Association (NYHA) class I or II at follow up, length of hospital stay, and procedural time. Ten studies (n = 24,111; AF = 12,789. No AF = 11,322) were included in the final analysis. Pre-existing AF was associated with higher overall all-cause mortality (OR 1.55, 95% CI 1.32-1.83, P<0.0002) and higher overall HF hospitalization rate (OR 1.3, 95% CI 1.08-1.56, P<0.0154). There was no statistically significant difference in cardiovascular mortality, in-hospital mortality, stroke, length of hospital stay, procedural time, or NYHA class I/II at follow up comparing AF vs no AF. The presence of AF in patients undergoing TMVR with Mitraclip is associated with higher all-cause mortality and HF hospitalization. This should be taken into consideration in management of MR patients.