Impact of Gender on Outcomes of Transcatheter edge to edge mitral valve repair: A Meta-analysis.
Main Article Content
Abstract
Background: Gender disparities in outcomes after mitral valve surgery are well known. There are only few studies reporting the influence of gender on outcomes following transcatheter edge to edge repair (TEER) of the mitral valve using MitraClip (MC). In this meta-analysis, we describe outcomes by gender after mitral valve TEER.
Methods: Studies reporting gender specific outcomes in patients treated with MC were reviewed from January 2010 to February 2022. Outcomes evaluated include all-cause mortality, New York Heart Association (NYHA) class, readmission for heart failure and residual mitral regurgitation (MR) at the longest follow up. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using random effects models.
Results: Seventeen studies with 33,747 patients (19,303 males and 14,444 females) were included. There was no difference in all-cause mortality (OR: 1.00, 95% CI: [0.90-1.12], p=0.93), residual MR (OR: 0.59, 95% CI: [0.34-1.02], p=0.06) or readmission for heart failure (OR: 1.04, 95% CI: [0.69-1.57], p=0.83). However, NYHA class III/IV was more frequent in female patients as compared to male patients at the end of follow up (OR: 0.62, 95% CI: [0.51-0.74], p<0.00001).
Conclusions: Our meta-analysis, the largest to date, suggests that female patients have worse NHYA functional class after TEER without any difference in all-cause mortality, readmissions for heart failure or residual MR when compared to male patients.
Keywords:
Impact of Gender on Outcomes, mitral valve repair, Meta-analysis
Article Details
How to Cite
MUSTAFA, Usman et al.
Impact of Gender on Outcomes of Transcatheter edge to edge mitral valve repair: A Meta-analysis..
Medical Research Archives, [S.l.], v. 11, n. 7.2, aug. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4053>. Date accessed: 15 may 2024.
doi: https://doi.org/10.18103/mra.v11i7.2.4053.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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11. Baldi C, Citro R, Silverio A, Di Maio M, De Rosa R, Bonadies D, Verolino G, Esposito L, Mastrogiovanni G, Di Muro MR, Piscione F and Galasso G. Predictors of outcome in heart failure patients with severe functional mitral regurgitation undergoing MitraClip treatment. Int J Cardiol. 2019;284:50-58.
12. Doshi R, Shlofmitz E, Vadher A, Shah J and Meraj P. Impact of sex on short term in-hospital outcomes with transcatheter edge-to-edge mitral valve repair. Cardiovasc Revasc Med. 2018;19:182-185.
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14. Franzen O, van der Heyden J, Baldus S, Schluter M, Schillinger W, Butter C, Hoffmann R, Corti R, Pedrazzini G, Swaans MJ, Neuss M, Rudolph V, Surder D, Grunenfelder J, Eulenburg C, Reichenspurner H, Meinertz T and Auricchio A. MitraClip(R) therapy in patients with end-stage systolic heart failure. European journal of heart failure. 2011; 13:569-76.
15. Gafoor S, Sievert H, Maisano F, Baldus S, Schaefer U, Hausleiter J, Butter C, Ussia GP, Geist V, Widder JD, Moccetti T, Schillinger W and Franzen O. Gender in the ACCESS-EU registry: a prospective, multicentre, non-randomised post-market approval study of MitraClip(R) therapy in Europe. EuroIntervention. 2016;12:e257-64.
16. Gotzmann M, Sprenger I, Ewers A, Mugge A and Bosche L. One-year outcome of percutaneous mitral valve repair in patients with severe symptomatic mitral valve regurgitation. World J Cardiol. 2017;9:39-46.
17. Park SD, Orban M, Karam N, Lubos E, Kalbacher D, Braun D, Stolz L, Neuss M, Butter C, Praz F, Kassar M, Petrescu A, Pfister R, Iliadis C, Unterhuber M, Lurz P, Thiele H, Baldus S, von Bardeleben S, Blankenberg S, Massberg S, Windecker S, Hausleiter J and Euro SMRI. Sex-Related Clinical Characteristics and Outcomes of Patients Undergoing Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation. JACC Cardiovasc Interv. 2021;14:819-827.
18. Schlüter M, Lubs D, Lubos E, Rudolph V, Treede H, Schirmer J, Conradi L, Reichenspurner H, Baldus S, Blankenberg S and Goldmann B. TCT-695 A Gender-Specific Look at MitraClip Therapy in Surgical High-Risk Patients: Acute and Long-Term Outcomes. J Am Coll Cardiol. 2013;62:B212-B212.
19. Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, Whisenant B, Grayburn PA, Rinaldi M, Kapadia SR, Rajagopal V, Sarembock IJ, Brieke A, Marx SO, Cohen DJ, Weissman NJ, Mack MJ and Investigators C. Transcatheter Mitral-Valve Repair in Patients with Heart Failure. The New England journal of medicine. 2018;379:2307-2318.
20. Tigges E, Kalbacher D, Thomas C, Appelbaum S, Deuschl F, Schofer N, Schluter M, Conradi L, Schirmer J, Treede H, Reichenspurner H, Blankenberg S, Schafer U and Lubos E. Transcatheter Mitral Valve Repair in Surgical High-Risk Patients: Gender-Specific Acute and Long-Term Outcomes. Biomed Res Int. 2016;2016:3934842.
21. von Bardeleben RS, Hobohm L, Kreidel F, Ostad MA, Schulz E, Konstantinides S, Lankeit M, Feldman T, Munzel T and Keller K. Incidence and in-hospital safety outcomes of patients undergoing percutaneous mitral valve edge-to-edge repair using MitraClip: five-year German national patient sample including 13,575 implants. EuroIntervention. 2019;14:1725-1732.
22. Werner N, Puls M, Baldus S, Lubos E, Bekeredjian R, Sievert H, Schofer J, Kuck KH, Mollmann H, Hehrlein C, Nickenig G, Boekstegers P, Ouarrak T, Senges J, Zahn R and German Transcatheter Mitral Valve Intervention i. Gender-related differences in patients undergoing transcatheter mitral valve interventions in clinical practice: 1-year results from the German TRAMI registry. Catheter Cardiovasc Interv. 2020;95:819-829.
23. Khan MZ, Zahid S, Khan MU, Khan SU, Munir MB and Balla S. Gender Disparities in ercutaneous Mitral Valve Repair (from the National Inpatient Sample). The American journal of cardiology. 2020;132:179-181.
24. Paulus MG, Meindl C, Bohm L, Holzapfel M, Hamerle M, Schach C, Maier LS, Debl K, Unsold B and Birner C. Predictors of functional improvement in the short term after MitraClip implantation in patients with secondary mitral regurgitation. PLoS One. 2020;15:e0232817.
25. Kosmidou I, Lindenfeld J, Abraham WT, Rinaldi MJ, Kapadia SR, Rajagopal V, Sarembock IJ, Brieke A, Gaba P, Rogers JH, Shahim B, Redfors B, Zhang Z, Mack MJ and Stone GW. Sex-Specific Outcomes of Transcatheter Mitral-Valve Repair and Medical Therapy for Mitral Regurgitation in Heart Failure. JACC Heart failure. 2021;9:674-683.
26. Vassileva CM, McNeely C, Mishkel G, Boley T, Markwell S and Hazelrigg S. Gender differences in long-term survival of Medicare beneficiaries undergoing mitral valve operations. The Annals of thoracic surgery. 2013;96:1367-1373.
27. Seeburger J, Eifert S, Pfannmuller B, Garbade J, Vollroth M, Misfeld M, Borger M and Mohr FW. Gender differences in mitral valve surgery. Thorac Cardiovasc Surg. 2013;61:42-6.
2. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, 3rd, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, Rigolin VH, Sundt TM, 3rd and Thompson A. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017; 70:252-289.
3. Bonow RO, O'Gara PT, Adams DH, Badhwar V, Bavaria JE, Elmariah S, Hung JW, Lindenfeld J, Morris AA, Satpathy R, Whisenant B and Woo YJ. 2020 Focused Update of the 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2020;75:2236-2270.
4. Feldman T, Foster E, Glower DD, Kar S, Rinaldi MJ, Fail PS, Smalling RW, Siegel R, Rose GA, Engeron E, Loghin C, Trento A, Skipper ER, Fudge T, Letsou GV, Massaro JM, Mauri L and Investigators EI. Percutaneous repair or surgery for mitral regurgitation. The New England journal of medicine. 2011; 364:1395-406.
5. Stone GW, Abraham WT, Lindenfeld J, Kar S, Grayburn PA, Lim DS, Mishell JM, Whisenant B, Rinaldi M, Kapadia SR, Rajagopal V, Sarembock IJ, Brieke A, Marx SO, Cohen DJ, Asch FM, Mack MJ and Investigators C. Five-Year Follow-up after Transcatheter Repair of Secondary Mitral Regurgitation. The New England journal of medicine. 2023;388:2037-2048.
6. Nitsche C, Koschutnik M, Kammerlander A, Hengstenberg C and Mascherbauer J. Gender-specific differences in valvular heart disease. Wien Klin Wochenschr. 2020;132:61-68.
7. Moher D, Liberati A, Tetzlaff J, Altman DG and Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.
8. DerSimonian R and Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986; 7:177-88.
9. Arturo Giordano CI, Cesare Baldi, Paolo Ferraro, Nicola Corcione, Michele Polimeno, Stefano Messina,, Filippo Finizio AM, Raffaella Avellino, Giuseppe Biondi-Zoccai, Giacomo Frati, Massimo and Mancone GS. Comparison of Men Versus Women Undergoing Transcatheter Mitral Valve Repair With Mitraclip. Journal of Cardiol Ther. 2015;2:285-290.
10. Attizzani GF, Ohno Y, Capodanno D, Cannata S, Dipasqua F, Imme S, Mangiafico S, Barbanti M, Ministeri M, Cageggi A, Pistritto AM, Giaquinta S, Farruggio S, Chiaranda M, Ronsivalle G, Scandura S, Tamburino C, Capranzano P and Grasso C. Gender-related clinical and echocardiographic outcomes at 30-day and 12-month follow up after MitraClip implantation in the GRASP registry. Catheter Cardiovasc Interv. 2015;85:889-97.
11. Baldi C, Citro R, Silverio A, Di Maio M, De Rosa R, Bonadies D, Verolino G, Esposito L, Mastrogiovanni G, Di Muro MR, Piscione F and Galasso G. Predictors of outcome in heart failure patients with severe functional mitral regurgitation undergoing MitraClip treatment. Int J Cardiol. 2019;284:50-58.
12. Doshi R, Shlofmitz E, Vadher A, Shah J and Meraj P. Impact of sex on short term in-hospital outcomes with transcatheter edge-to-edge mitral valve repair. Cardiovasc Revasc Med. 2018;19:182-185.
13. Estevez-Loureiro R, Settergren M, Winter R, Jacobsen P, Dall'Ara G, Sondergaard L, Cheung G, Pighi M, Ghione M, Ihlemann N, Moat NE, Price S, Streit Rosenberg T, Di Mario C and Franzen O. Effect of gender on results of percutaneous edge-to-edge mitral valve repair with MitraClip system. The American journal of cardiology. 2015;116:275-9.
14. Franzen O, van der Heyden J, Baldus S, Schluter M, Schillinger W, Butter C, Hoffmann R, Corti R, Pedrazzini G, Swaans MJ, Neuss M, Rudolph V, Surder D, Grunenfelder J, Eulenburg C, Reichenspurner H, Meinertz T and Auricchio A. MitraClip(R) therapy in patients with end-stage systolic heart failure. European journal of heart failure. 2011; 13:569-76.
15. Gafoor S, Sievert H, Maisano F, Baldus S, Schaefer U, Hausleiter J, Butter C, Ussia GP, Geist V, Widder JD, Moccetti T, Schillinger W and Franzen O. Gender in the ACCESS-EU registry: a prospective, multicentre, non-randomised post-market approval study of MitraClip(R) therapy in Europe. EuroIntervention. 2016;12:e257-64.
16. Gotzmann M, Sprenger I, Ewers A, Mugge A and Bosche L. One-year outcome of percutaneous mitral valve repair in patients with severe symptomatic mitral valve regurgitation. World J Cardiol. 2017;9:39-46.
17. Park SD, Orban M, Karam N, Lubos E, Kalbacher D, Braun D, Stolz L, Neuss M, Butter C, Praz F, Kassar M, Petrescu A, Pfister R, Iliadis C, Unterhuber M, Lurz P, Thiele H, Baldus S, von Bardeleben S, Blankenberg S, Massberg S, Windecker S, Hausleiter J and Euro SMRI. Sex-Related Clinical Characteristics and Outcomes of Patients Undergoing Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation. JACC Cardiovasc Interv. 2021;14:819-827.
18. Schlüter M, Lubs D, Lubos E, Rudolph V, Treede H, Schirmer J, Conradi L, Reichenspurner H, Baldus S, Blankenberg S and Goldmann B. TCT-695 A Gender-Specific Look at MitraClip Therapy in Surgical High-Risk Patients: Acute and Long-Term Outcomes. J Am Coll Cardiol. 2013;62:B212-B212.
19. Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, Whisenant B, Grayburn PA, Rinaldi M, Kapadia SR, Rajagopal V, Sarembock IJ, Brieke A, Marx SO, Cohen DJ, Weissman NJ, Mack MJ and Investigators C. Transcatheter Mitral-Valve Repair in Patients with Heart Failure. The New England journal of medicine. 2018;379:2307-2318.
20. Tigges E, Kalbacher D, Thomas C, Appelbaum S, Deuschl F, Schofer N, Schluter M, Conradi L, Schirmer J, Treede H, Reichenspurner H, Blankenberg S, Schafer U and Lubos E. Transcatheter Mitral Valve Repair in Surgical High-Risk Patients: Gender-Specific Acute and Long-Term Outcomes. Biomed Res Int. 2016;2016:3934842.
21. von Bardeleben RS, Hobohm L, Kreidel F, Ostad MA, Schulz E, Konstantinides S, Lankeit M, Feldman T, Munzel T and Keller K. Incidence and in-hospital safety outcomes of patients undergoing percutaneous mitral valve edge-to-edge repair using MitraClip: five-year German national patient sample including 13,575 implants. EuroIntervention. 2019;14:1725-1732.
22. Werner N, Puls M, Baldus S, Lubos E, Bekeredjian R, Sievert H, Schofer J, Kuck KH, Mollmann H, Hehrlein C, Nickenig G, Boekstegers P, Ouarrak T, Senges J, Zahn R and German Transcatheter Mitral Valve Intervention i. Gender-related differences in patients undergoing transcatheter mitral valve interventions in clinical practice: 1-year results from the German TRAMI registry. Catheter Cardiovasc Interv. 2020;95:819-829.
23. Khan MZ, Zahid S, Khan MU, Khan SU, Munir MB and Balla S. Gender Disparities in ercutaneous Mitral Valve Repair (from the National Inpatient Sample). The American journal of cardiology. 2020;132:179-181.
24. Paulus MG, Meindl C, Bohm L, Holzapfel M, Hamerle M, Schach C, Maier LS, Debl K, Unsold B and Birner C. Predictors of functional improvement in the short term after MitraClip implantation in patients with secondary mitral regurgitation. PLoS One. 2020;15:e0232817.
25. Kosmidou I, Lindenfeld J, Abraham WT, Rinaldi MJ, Kapadia SR, Rajagopal V, Sarembock IJ, Brieke A, Gaba P, Rogers JH, Shahim B, Redfors B, Zhang Z, Mack MJ and Stone GW. Sex-Specific Outcomes of Transcatheter Mitral-Valve Repair and Medical Therapy for Mitral Regurgitation in Heart Failure. JACC Heart failure. 2021;9:674-683.
26. Vassileva CM, McNeely C, Mishkel G, Boley T, Markwell S and Hazelrigg S. Gender differences in long-term survival of Medicare beneficiaries undergoing mitral valve operations. The Annals of thoracic surgery. 2013;96:1367-1373.
27. Seeburger J, Eifert S, Pfannmuller B, Garbade J, Vollroth M, Misfeld M, Borger M and Mohr FW. Gender differences in mitral valve surgery. Thorac Cardiovasc Surg. 2013;61:42-6.