Postdischarge-to-30-Day Mortality Among Patients Receiving MitraClip: A Systematic Review and Meta-Analysis
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...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-04-01
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| Series: | Structural Heart |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2474870622012611 |
| _version_ | 1811325977498746880 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Beni R. Verma, MD |
| collection | DOAJ |
| description | 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 < 0.001), and prolonged ventilation >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. |
| first_indexed | 2024-04-13T14:42:20Z |
| format | Article |
| id | doaj.art-38bc80278241476fa73aa3f3aadabab5 |
| institution | Directory Open Access Journal |
| issn | 2474-8706 |
| language | English |
| last_indexed | 2024-04-13T14:42:20Z |
| publishDate | 2022-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Structural Heart |
| spelling | doaj.art-38bc80278241476fa73aa3f3aadabab52022-12-22T02:42:52ZengElsevierStructural Heart2474-87062022-04-0161100011Postdischarge-to-30-Day Mortality Among Patients Receiving MitraClip: A Systematic Review and Meta-AnalysisBeni R. Verma, MD0Shashank Shekhar, MD1Toshiaki Isogai, MD2Raghuram Chava, MD3Pejman Raeisi-Giglou, DO4Agam Bansal, MD5Shameer Khubber, MD6Bryce Montane, MD7Prashansha Vaidya, MD8Simrat Kaur, MD9Manpreet Kaur, MD10Rhonda Miyasaka, MD11Serge C. Harb, MD12Amar Krishnaswamy, MD13Samir R. Kapadia, MD14Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USAHeart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USAHeart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USADepartment of Cardiology, Case Western MetroHealth Health System, Cleveland, Ohio, USADepartment of Cardiology, Case Western MetroHealth Health System, Cleveland, Ohio, USAHeart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USAHeart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USAHeart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USADepartment of Surgery, Cleveland Clinic, Cleveland, Ohio, USAHeart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USAHeart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USAHeart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USAHeart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USAHeart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USAHeart 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 44195Background: 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 < 0.001), and prolonged ventilation >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.http://www.sciencedirect.com/science/article/pii/S2474870622012611Heart failureMitral valve diseaseMortalityPercutaneous valve therapyStructural heart disease intervention |
| spellingShingle | 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 Postdischarge-to-30-Day Mortality Among Patients Receiving MitraClip: A Systematic Review and Meta-Analysis Structural Heart Heart failure Mitral valve disease Mortality Percutaneous valve therapy Structural heart disease intervention |
| title | Postdischarge-to-30-Day Mortality Among Patients Receiving MitraClip: A Systematic Review and Meta-Analysis |
| title_full | Postdischarge-to-30-Day Mortality Among Patients Receiving MitraClip: A Systematic Review and Meta-Analysis |
| title_fullStr | Postdischarge-to-30-Day Mortality Among Patients Receiving MitraClip: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Postdischarge-to-30-Day Mortality Among Patients Receiving MitraClip: A Systematic Review and Meta-Analysis |
| title_short | Postdischarge-to-30-Day Mortality Among Patients Receiving MitraClip: A Systematic Review and Meta-Analysis |
| title_sort | postdischarge to 30 day mortality among patients receiving mitraclip a systematic review and meta analysis |
| topic | Heart failure Mitral valve disease Mortality Percutaneous valve therapy Structural heart disease intervention |
| url | http://www.sciencedirect.com/science/article/pii/S2474870622012611 |
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