Percutaneous mitral-valve intervention for secondary mitral regurgitation: data from real-life.

Many questions were raised due to the divergent results between COAPT and MITRA-FR trials on the use of percutaneous mitral valve repair (PMVr) for secondary mitral regurgitation (SMR). This paper examined pooled patients' characteristics and outcomes from real-life experience compared with those in the two landmark trials. A comprehensive search identified eligible studies published in 2020 and 2021. Mean difference and odds ratio (OR) were used to compare continuous and categorical data. Thirty-three studies included more than 9200 patients. Patients in landmark trials were younger than in real-life, less likely to present with severe heart failure symptoms [(COAPT: OR 0.25; 95% CI: 0.21, 0.31); (MITRA-FR: OR 0.32; 95% CI: 0.23, 0.45)] or severe MR grade (COAPT only: OR 0.57; 95% CI: 0.45, 0.71) with larger left ventricular end diastolic volume. Procedure success (OR 1.94; 95% CI: 1.10, 3.40) was more frequent with lower all-cause mortality (OR 0.73; 95% CI: 0.54, 0.99) in COAPT. Real-life patients experienced more favorable procedural and clinical outcomes compared with MITRA-FR patients. Real-life data on PMVr in SMR showed important variations in patient selection and procedural outcomes. Rates of death and heart failure hospitalization in observational studies were lower than MITRA-FR but higher than COAPT trial.