Clinical outcomes of transcatheter edge-to-edge mitral valve repair (M-TEER) in patients with and without cancer history: a systematic review and meta-analysis
K Keramida, K Karampinos, S Liori, P Nikolopoulos, C Kapelios, D FarmakisAbstract
Introduction
Patients with active cancer or history of malignancy often constitute a group with increased cardiovascular risk. The use of transcatheter edge-to-edge mitral valve repair (M-TEER) primarily in patients with severe secondary mitral regurgitation has increased substantially. However, the impact of coexisting cancer on the clinical outcomes of this specialized therapy remains unclear. The scope of this current meta-analysis was to evaluate the impact of a history of malignancy or active cancer on the short- and mid-term outcomes of patients undergoing M-TEER.
Methods
A systematic review and meta-analysis of observational studies comparing patients with and without cancer after M-TEER was conducted. Primary endpoints included all-cause mortality (30-day, 1-year), heart failure hospitalizations (HFH), stroke, and major bleeding. A random-effects model was used, with the Peto method applied, where appropriate. Heterogeneity was assessed using the I² and Q statistics, and publication bias was evaluated with Egger’s and Begg’s tests and the trim-and-fill method, where appropriate.
Results
A total of 9 studies comprising 31,384 patients were included, of whom 2,526 had a history of cancer or active malignancy. All-cause mortality at 1 year did not differ significantly between groups (RR = 1.10, 95% CI 0.97-1.28, p = 0.10). Similarly, 30-day mortality after the procedure (RR = 0.69, p = 0.14) and HFHs at 30 days and 1 year did not differ significantly (RR = 1.15, p = 0.22; RR = 1.16, p = 0.37, respectively). However, patients with cancer had a higher risk of stroke (RR = 2.02, p = 0.003), while no significant differences were observed in major post-procedural bleeding.
Conclusions
The presence of malignancy is not associated with increased all-cause mortality or HFHs after M-TEER, but it is seemingly linked to a significantly higher risk of stroke. Larger future studies are warranted to better understand the underlying mechanisms and to individualize peri-procedural strategies in oncology patients undergoing M-TEER.