Transcatheter mitral edge-to-edge repair vs optimal medical therapy in secondary mitral regurgitation: a meta-analysis.

INTRODUCTION AND OBJECTIVES: Mitral regurgitation is one of the most common heart valve diseases. Valve replacement surgery is a guideline-recommended option; however, in a significant proportion of patients, this option is not feasible. In such cases, mitral transcatheter edge-to-edge repair (M-TEER) is a potential therapeutic alternative. Nevertheless, the results of a randomized clinical trial have shown divergent results. Recently, the results of the RESHAPE-HF2 trial were published, providing additional insights. The objective of this work is to evaluate whether there are any differences between performing M-TEER and keeping patients under guideline-directed medical therapy (GDMT). METHODS: We conducted a meta-analysis following the PRISMA guidelines. We searched for studies across the PubMed, Embase, and Cochrane databases until February 2025. We establish the following inclusion criteria: patients with secondary mitral regurgitation, studies comparing M-TEER plus GDMT vs GDMT alone, and who reported hospitalization due to heart failure (HF) or mortality. RESULTS: A total of 3 randomized clinical trials meet the inclusion criteria, including a total of 1423 patients: 704 received M-TEER and 719, GDMT alone. M-TEER was associated with a reduced risk of HF-related hospitalization with a risk ratio (RR) of 0.71 (95%CI, 0.56-0.90; P = .004). We did not find any differences in all-cause mortality with a RR of 0.80 (95%CI, 0.63-1.02; P = .07). CONCLUSIONS: In this meta-analysis, M-TEER plus GDMT shows a lower risk of HF-related hospitalization vs GDMT alone. We did not find any differences in the risk of all-cause mortality or cardiac death.Registered at PROSPERO: CRD42025645047.