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Stroke Risk After Mitral Valve Interventions: A Systematic Review and Network Meta-Analysis Publisher Pubmed



Kazemian S1 ; Bansal K2 ; Kuno T3 ; Gupta T4 ; Goel K5 ; Khera S6 ; Alkhouli M7 ; Kolte D8
Authors
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Authors Affiliations
  1. 1. Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts, United States
  3. 3. Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, United States
  4. 4. Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont, United States
  5. 5. Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, United States
  6. 6. Division of Interventional Cardiology, Mount Sinai Hospital, New York, New York, United States
  7. 7. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
  8. 8. Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States

Source: American Journal of Cardiology Published:2024


Abstract

Previous research indicates varying stroke rates after mitral valve (MV) interventions. This study aimed to compare postprocedural stroke risks after transcatheter and surgical MV interventions. Electronic databases were searched from inception to February 2024 for studies comparing stroke rates after mitral transcatheter edge-to-edge repair (mTEER), surgical MV repair/replacement, or guideline-directed medical therapy (GDMT). Primary end points were all-time and early (<30 days) stroke. Secondary outcomes included new-onset atrial fibrillation and 1-year all-cause mortality. A frequentist network meta-analysis was employed to compare outcomes. The network meta-analysis included 18 studies (3 randomized controlled trials and 15 observational), with 51,703 patients. mTEER was associated with a decreased risk of all-time (odds ratio [OR] 0.61, 95% confidence interval [CI] 0.41 to 0.89) and early stroke (OR 0.41, 95% CI 0.33 to 0.51) compared with surgery, and a similar risk of all-time (OR 1.54, 95% CI 0.76 to 3.12) and early stroke (OR 2.12, 95% CI 0.53 to 8.47) compared with GDMT. Conversely, surgery was associated with an increased risk of all-time (OR 2.55, 95% CI 1.17 to 5.57) and early stroke (OR 5.15, 95% CI 1.27 to 20.84) compared with GDMT. There were no statistically significant differences in the risk of new-onset atrial fibrillation (OR 0.38, 95% CI 0.11 to 1.31) and 1-year all-cause mortality (OR 1.43, 95% CI 0.91 to 2.24) between mTEER versus surgery. In conclusion, mTEER was associated with a lower risk of stroke and similar risks of new-onset atrial fibrillation and 1-year mortality compared with surgical MV interventions. Further studies are needed to understand the mechanisms of stroke and to determine strategies to reduce stroke risk after MV interventions. © 2024 Elsevier Inc.
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