Postdischarge-to-30-Day Mortality Among Patients Receiving MitraClip: A Systematic Review and Meta-Analysis

Beni R. Verma, MD; Shashank Shekhar, MD; Toshiaki Isogai, MD; Raghuram Chava, MD; Pejman Raeisi-Giglou, DO; Agam Bansal, MD; Shameer Khubber, MD; Bryce Montane, MD; Prashansha Vaidya, MD; Simrat Kaur, MD; Manpreet Kaur, MD; Rhonda Miyasaka, MD; Serge C. Harb, MD; Amar Krishnaswamy, MD; Samir R. Kapadia, MD

Structural Heart (Apr 2022)

Postdischarge-to-30-Day Mortality Among Patients Receiving MitraClip: A Systematic Review and Meta-Analysis

Beni R. Verma, MD,
Shashank Shekhar, MD,
Toshiaki Isogai, MD,
Raghuram Chava, MD,
Pejman Raeisi-Giglou, DO,
Agam Bansal, MD,
Shameer Khubber, MD,
Bryce Montane, MD,
Prashansha Vaidya, MD,
Simrat Kaur, MD,
Manpreet Kaur, MD,
Rhonda Miyasaka, MD,
Serge C. Harb, MD,
Amar Krishnaswamy, MD,
Samir R. Kapadia, MD

Affiliations

Beni R. Verma, MD: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
Shashank Shekhar, MD: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
Toshiaki Isogai, MD: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
Raghuram Chava, MD: Department of Cardiology, Case Western MetroHealth Health System, Cleveland, Ohio, USA
Pejman Raeisi-Giglou, DO: Department of Cardiology, Case Western MetroHealth Health System, Cleveland, Ohio, USA
Agam Bansal, MD: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
Shameer Khubber, MD: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
Bryce Montane, MD: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
Prashansha Vaidya, MD: Department of Surgery, Cleveland Clinic, Cleveland, Ohio, USA
Simrat Kaur, MD: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
Manpreet Kaur, MD: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
Rhonda Miyasaka, MD: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
Serge C. Harb, MD: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
Amar Krishnaswamy, MD: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
Samir R. Kapadia, MD: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA; Address correspondence to: Samir R. Kapadia, MD, Cardiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue J2-3, Cleveland, OH 44195

Journal volume & issue: Vol. 6, no. 1
p. 100011

Abstract

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Background: MitraClip (MC) implantation is the recommended treatment for severe symptomatic mitral regurgitation in patients not responding to medical therapy and at prohibitive surgical risk. It is important to quantify immediate mortality during postdischarge-to-30-day period so as to improve the procedural outcomes. Hence, we aim to identify the incidence of postdischarge-to-30-day mortality and its associated predictors using the technique of meta-analysis. Methods: We searched Medline, Embase, and Cochrane CENTRAL databases from inception until July 3, 2019 for studies reporting mortality prior to discharge, at 30 days and 1 year after MC implantation. The primary outcome was postdischarge-to-30-day all-cause mortality. Results: Of 2394 references, 15 studies enrolling 7498 patients were included. Random effects analysis showed that all-cause cumulative inpatient, 30-day, and 1-year mortality was 2.40% (2.08, 2.77; I2 = 0%), 4.31% (3.64, 5.09, I2 = 41.9%), and 20.71% (18.32; 23.33, I2 = 81.5%), respectively. The postdischarge-to-30-day mortality was 1.70% (95% confidence interval: 1.0, 2.70; I2 = 84%). A total of 71.50% of deaths (95% confidence interval: 36.80-91.50, I2 = 63%) in the postdischarge-to-30-day period were due to cardiac etiology. On meta-regression, pre-MC left ventricular ejection fraction (p = 0.003), Log.Euroscore (p = 0.047), Society of Thoracic Surgeons Predicted Risk of Mortality (p 48 hours (p < 0.001) were found to be its significant predictors. Conclusions: Our meta-analysis reports an additional mortality of ∼2% immediately after MC implantation during the postdischarge-to-30-day period. Majority of deaths occurred due to cardiac causes. Pre-MC left ventricular ejection fraction, Log.Euroscore, Society of Thoracic Surgeons Predicted Risk of Mortality score, and prolonged ventilation were found to be its significant predictors. Further studies are needed to better understand the causes of this early mortality to maximize benefits of this important therapy.

Published in Structural Heart

ISSN: 2474-8706 (Print); 2474-8714 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.sciencedirect.com/journal/structural-heart

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