Efficacy of MitraClip in functional versus degenerative mitral regurgitation: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Xuhua ¹ , BAI Qiyuan ¹ , WEI Zhili ¹ , LIU Shidong ² , CHEN Hao ¹ , CHEN Yang ¹ ,  SONG Bing ²

1. The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, P. R. China;
2. Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, P. R. China;

Corresponding?author：

SONG Bing, Email: songbinldyy@163.com

Keywords：

Transcatheter edge-to-edge repair; MitraClip; functional mitral regurgitation; degenerative mitral regurgitation; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202404036

Video：

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Objective To systematically evaluate the differences in outcomes between functional mitral regurgitation (FMR) and degenerative mitral regurgitation (DMR) in patients treated with transcatheter edge-to-edge repair (TEER) using the MitraClip device. Methods A systematic literature search was conducted in PubMed, Embase, the Cochrane Library, Web of Science, the CNKI, Wanfang Database, VIP Database, and the CBM from their inception to January 2024. Two researchers independently performed study selection, data extraction, and risk of bias assessment. The quality of cohort studies was evaluated using the Newcastle-Ottawa Scale (NOS). A meta-analysis was performed using Stata 18.0 software. Results A total of 13 cohort studies involving 6 402 patients were included, comprising 4 161 patients in the FMR group and 2 241 in the DMR group. All included studies had NOS scores of ≥6 points. The meta-analysis revealed that compared to the DMR group, the FMR group had a higher 1-year all-cause mortality rate [OR=1.53, 95%CI (1.30, 1.81), P＜0.01] and a higher 1-year rehospitalization rate for heart failure [OR=1.90, 95%CI (1.60, 2.26), P＜0.01]. Conversely, the FMR group had a lower post-procedural mean transmitral gradient [SMD=–0.47, 95%CI (–0.65, –0.30), P＜0.01] and a lower rate of subsequent mitral valve surgery [OR=0.41, 95%CI (0.20, 0.83), P=0.01]. Conclusion Following MitraClip therapy, patients with FMR exhibit favorable short-term outcomes, but their mid- to long-term outcomes are inferior to those of patients with DMR. When determining the treatment strategy with MitraClip, the specific etiology of mitral regurgitation should be considered for a more accurate prediction of therapeutic efficacy and prognosis.

Citation： LI Xuhua, BAI Qiyuan, WEI Zhili, LIU Shidong, CHEN Hao, CHEN Yang, SONG Bing. Efficacy of MitraClip in functional versus degenerative mitral regurgitation: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(5): 807-814. doi: 10.7507/1007-4848.202404036 Copy

1.	Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. Lancet, 2006, 368(9540): 1005-1011.
2.	Trichon BH, Felker GM, Shaw LK, et al. Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure. Am J Cardiol, 2003, 91(5): 538-543.
3.	Hu P, Liu XB, Liang J, et al. A hospital-based survey of patients with severe valvular heart disease in China. Int J Cardiol, 2017, 231: 244-247.
4.	葉蘊青, 許海燕, 李喆, 等. 中國不同區域老年瓣膜性心臟病構成和病因分析. 中華老年心腦血管病雜志, 2019, 21(7): 676-682.Ye YQ, Xu HY, Li Z, et al. Analysis of composition and etiology of valvular heart disease in the elderly in different regions of China. Chin J Geriatr Heart Brain Vessel Dis, 2019, 21(7): 676-682.
5.	潘文志, 周達新, 葛均波. 中國二尖瓣反流患者人群數量的估測. 中國胸心血管外科臨床雜志, 2021, 28(5): 495-498.Pan WZ, Zhou DX, Ge JB. Estimation of the number of patients with mitral regurgitation in China. Chin J Clin Thorac Cardiovasc Surg, 2021, 28(5): 495-498.
6.	潘翠珍, 潘文志, 周達新. 二尖瓣反流介入治療的超聲心動圖評價中國專家共識. 中國介入心臟病學雜志, 2019, 27(1): 6-12.Pan CZ, Pan WZ, Zhou DX. Chinese expert consensus on echocardiographic evaluation for interventional therapy of mitral regurgitation. Chin J Interv Cardiol, 2019, 27(1): 6-12.
7.	陳濤, 于波. 經導管二尖瓣緣對緣修復術在二尖瓣反流中的應用進展. 華西醫學, 2023, 38(9): 1281-1287.Chen T, Yu B. Progress in the application of transcatheter edge-to-edge mitral valve repair for mitral regurgitation. West China Med J, 2023, 38(9): 1281-1287.
8.	Head SJ, van Leeuwen WJ, Van Mieghem NM, et al. Surgical or transcatheter mitral valve intervention: complex disease requires complex decisions. EuroIntervention, 2014, 9(10): 1133-1135.
9.	Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
10.	Nishimura RA, Otto CM, Bonow RO, et al. 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. Circulation, 2017, 135(25): e1159-e1195.
11.	Sorajja P, Vemulapalli S, Feldman T, et al. Outcomes with transcatheter mitral valve repair in the United States: an STS/ACC TVt registry report. J Am Coll Cardiol, 2017, 70(19): 2315-2327.
12.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
13.	Mauri L, Foster E, Glower DD, et al. 4-year results of a randomized controlled trial of percutaneous repair versus surgery for mitral regurgitation. J Am Coll Cardiol, 2013, 62(4): 317-328.
14.	Baldus S, Schillinger W, Franzen O, et al. MitraClip therapy in daily clinical practice: initial results from the German transcatheter mitral valve interventions (TRAMI) registry. Eur J Heart Fail, 2012, 14(9): 1050-1055.
15.	Maisano F, Franzen O, Baldus S, et al. Percutaneous mitral valve interventions in the real world: early and 1-year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe. J Am Coll Cardiol, 2013, 62(12): 1052-1061.
16.	Grasso C, Capodanno D, Scandura S, et al. One- and twelve-month safety and efficacy outcomes of patients undergoing edge-to-edge percutaneous mitral valve repair (from the GRASP Registry). Am J Cardiol, 2013, 111(10): 1482-1487.
17.	Nickenig G, Estevez-Loureiro R, Franzen O, et al. Percutaneous mitral valve edge-to-edge repair: in-hospital results and 1-year follow-up of 628 patients of the 2011-2012 Pilot European Sentinel Registry. J Am Coll Cardiol, 2014, 64(9): 875-884.
18.	Bonow RO, Carabello B, de Leon AC, et al. ACC/AHA guidelines for the management of patients with valvular heart disease. Executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease). J Heart Valve Dis, 1998, 7(6): 672-707.
19.	Stone GW, Lindenfeld J, Abraham WT, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med, 2018, 379(24): 2307-2318.
20.	Bavry AA, Arnaoutakis GJ. Perspective to 2020 American College of Cardiology/American Heart Association (ACC/AHA) guideline for the management of patients with valvular heart disease. Circulation, 2021, 143(5): 407-409.
21.	Feldman T, Foster E, Glower DD, et al. Percutaneous repair or surgery for mitral regurgitation. N Engl J Med, 2011, 364(15): 1395-1406.
22.	Liu XH, Shi JY, Feng XJ, et al. Short-term and 1-year outcomes after MitraClip therapy in functional versus degenerative mitral regurgitation patients: a systematic review and meta-analysis. J Thorac Dis, 2018, 10(7): 4156-4168.
23.	Chiarito M, Pagnesi M, Martino EA, et al. Outcome after percutaneous edge-to-edge mitral repair for functional and degenerative mitral regurgitation: a systematic review and meta-analysis. Heart, 2018, 104(4): 306-312.
24.	Cota GF, de Sousa MR, Fereguetti TO, et al. Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIV infected patients: a systematic review with indirect comparison. PLoS Negl Trop Dis, 2013, 7(5): e2195.
25.	Henández-Vaquero D, Pascual I, Almendarez M, et al. Initial experience of a MitraClip valve repair program in Spain. Ann Transl Med, 2020, 8(15): 957.
26.	Kar S, von Bardeleben RS, Rottbauer W, et al. Contemporary outcomes following transcatheter edge-to-edge repair: 1-year results from the EXPAND study. JACC Cardiovasc Interv, 2023, 16(5): 589-602.
27.	Kheifets M, Angelini F, D'Ascenzo F, et al. Outcomes of transcatheter edge-to-edge repair in degenerative vs. functional mitral regurgitation. J Clin Med, 2022, 11(20): 6010.
28.	Mantegazza V, Pasquini A, Agati L, et al. Comprehensive assessment of mitral valve geometry and cardiac remodeling with 3-dimensional echocardiography after percutaneous mitral valve repair. Am J Cardiol, 2018, 122(7): 1195-1203.
29.	?ztürk C, Friederich M, Werner N, et al. Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve. Cardiol J, 2021, 28(2): 215-222.
30.	Pascual I, Arzamendi D, Carrasco-Chinchilla F, et al. Transcatheter mitral repair according to the cause of mitral regurgitation: real-life data from the Spanish MitraClip registry. Rev Esp Cardiol (Engl Ed), 2020, 73(8): 643-651.
31.	Patzelt J, Zhang W, Sauter R, et al. Elevated mitral valve pressure gradient is predictive of long-term outcome after percutaneous edge-to-edge mitral valve repair in patients with degenerative mitral regurgitation (MR), but not in functional MR. J Am Heart Assoc, 2019, 8(13): e011366.
32.	Perl L, Kheifets M, Guido A, et al. Acute reduction in left ventricular function following transcatheter mitral edge-to-edge repair. J Am Heart Assoc, 2023, 12(13): e029735.
33.	Rudolph V, Lubos E, Schlüter M, et al. Aetiology of mitral regurgitation differentially affects 2-year adverse outcomes after MitraClip therapy in high-risk patients. Eur J Heart Fail, 2013, 15(7): 796-807.
34.	Schueler R, Kaplan S, Melzer C, et al. Impact of interventional edge-to-edge repair on mitral valve geometry. Int J Cardiol, 2017, 230: 468-475.
35.	Seeger J, Müller P, Gonska B, et al. Percutaneous mitral valve repair with the MitraClip in primary compared with secondary mitral valve regurgitation using the mitral valve academic research consortium criteria. J Invas Cardiol, 2017, 29(4): 145-50.
36.	Yoon SH, Makar M, Kar S, et al. Outcomes after transcatheter edge-to-edge mitral valve repair according to mitral regurgitation etiology and cardiac remodeling. JACC Cardiovasc Interv, 2022, 15(17): 1711-1722.
37.	Goliasch G, Bartko PE, Pavo N, et al. Refining the prognostic impact of functional mitral regurgitation in chronic heart failure. Eur Heart J, 2018, 39(1): 39-46.
38.	Mack MJ, Lindenfeld J, Abraham WT, et al. 3-year outcomes of transcatheter mitral valve repair in patients with heart failure. J Am Coll Cardiol, 2021, 77(8): 1029-1040.
39.	Yeo KK, Yap J, Yamen E, et al. Percutaneous mitral valve repair with the MitraClip: early results from the MitraClip Asia-Pacific Registry (MARS). EuroIntervention, 2014, 10(5): 620-625.
40.	Tay E, Muda N, Yap J, et al. The MitraClip Asia-Pacific Registry: differences in outcomes between functional and degenerative mitral regurgitation. Catheter Cardiovasc Interv, 2016, 87(7): E275-281.
41.	Franzen O, van der Heyden J, Baldus S, et al. MitraClip? therapy in patients with end-stage systolic heart failure. Eur J Heart Fail, 2011, 13(5): 569-576.
42.	He S, Fontaine AA, Schwammenthal E, et al. Integrated mechanism for functional mitral regurgitation: leaflet restriction versus coapting force: in vitro studies. Circulation, 1997, 96(6): 1826-1834.
43.	He S, Lemmon JD Jr, Weston MW, et al. Mitral valve compensation for annular dilatation: in vitro study into the mechanisms of functional mitral regurgitation with an adjustable annulus model. J Heart Valve Dis, 1999, 8(3): 294-302.
44.	Kono T, Sabbah HN, Rosman H, et al. Left ventricular shape is the primary determinant of functional mitral regurgitation in heart failure. J Am Coll Cardiol, 1992, 20(7): 1594-1598.
45.	Raposeiras-Roubin S, Adamo M, Freixa X, et al. A score to assess mortality after percutaneous mitral valve repair. J Am Coll Cardiol, 2022, 79(6): 562-573.
46.	Eggebrecht H, Schelle S, Puls M, et al. Risk and outcomes of complications during and after MitraClip implantation: experience in 828 patients from the German TRAnscatheter mitral valve interventions (TRAMI) registry. Catheter Cardiovasc Interv, 2015, 86(4): 728-735.
47.	荊朝輝, 榮曉松, 焦國慶, 等. 合并重度肺動脈高壓的二尖瓣疾病行二尖瓣置換術的安全性. 國際心血管病雜志, 2024, 51(1): 62-64.Jing ZH, Rong XS, Jiao GQ, et al. Safety of mitral valve replacement for mitral valve disease complicated with severe pulmonary hypertension. Int J Cardiovasc Dis, 2024, 51(1): 62-64.
48.	Chan KL, Chen SY, Chan V, et al. Functional significance of elevated mitral gradients after repair for degenerative mitral regurgitation. Circ Cardiovasc Imaging, 2013, 6(6): 1041-1047.

1. Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. Lancet, 2006, 368(9540): 1005-1011.
2. Trichon BH, Felker GM, Shaw LK, et al. Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure. Am J Cardiol, 2003, 91(5): 538-543.
3. Hu P, Liu XB, Liang J, et al. A hospital-based survey of patients with severe valvular heart disease in China. Int J Cardiol, 2017, 231: 244-247.
4. 葉蘊青, 許海燕, 李喆, 等. 中國不同區域老年瓣膜性心臟病構成和病因分析. 中華老年心腦血管病雜志, 2019, 21(7): 676-682.Ye YQ, Xu HY, Li Z, et al. Analysis of composition and etiology of valvular heart disease in the elderly in different regions of China. Chin J Geriatr Heart Brain Vessel Dis, 2019, 21(7): 676-682.
5. 潘文志, 周達新, 葛均波. 中國二尖瓣反流患者人群數量的估測. 中國胸心血管外科臨床雜志, 2021, 28(5): 495-498.Pan WZ, Zhou DX, Ge JB. Estimation of the number of patients with mitral regurgitation in China. Chin J Clin Thorac Cardiovasc Surg, 2021, 28(5): 495-498.
6. 潘翠珍, 潘文志, 周達新. 二尖瓣反流介入治療的超聲心動圖評價中國專家共識. 中國介入心臟病學雜志, 2019, 27(1): 6-12.Pan CZ, Pan WZ, Zhou DX. Chinese expert consensus on echocardiographic evaluation for interventional therapy of mitral regurgitation. Chin J Interv Cardiol, 2019, 27(1): 6-12.
7. 陳濤, 于波. 經導管二尖瓣緣對緣修復術在二尖瓣反流中的應用進展. 華西醫學, 2023, 38(9): 1281-1287.Chen T, Yu B. Progress in the application of transcatheter edge-to-edge mitral valve repair for mitral regurgitation. West China Med J, 2023, 38(9): 1281-1287.
8. Head SJ, van Leeuwen WJ, Van Mieghem NM, et al. Surgical or transcatheter mitral valve intervention: complex disease requires complex decisions. EuroIntervention, 2014, 9(10): 1133-1135.
9. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
10. Nishimura RA, Otto CM, Bonow RO, et al. 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. Circulation, 2017, 135(25): e1159-e1195.
11. Sorajja P, Vemulapalli S, Feldman T, et al. Outcomes with transcatheter mitral valve repair in the United States: an STS/ACC TVt registry report. J Am Coll Cardiol, 2017, 70(19): 2315-2327.
12. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
13. Mauri L, Foster E, Glower DD, et al. 4-year results of a randomized controlled trial of percutaneous repair versus surgery for mitral regurgitation. J Am Coll Cardiol, 2013, 62(4): 317-328.
14. Baldus S, Schillinger W, Franzen O, et al. MitraClip therapy in daily clinical practice: initial results from the German transcatheter mitral valve interventions (TRAMI) registry. Eur J Heart Fail, 2012, 14(9): 1050-1055.
15. Maisano F, Franzen O, Baldus S, et al. Percutaneous mitral valve interventions in the real world: early and 1-year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe. J Am Coll Cardiol, 2013, 62(12): 1052-1061.
16. Grasso C, Capodanno D, Scandura S, et al. One- and twelve-month safety and efficacy outcomes of patients undergoing edge-to-edge percutaneous mitral valve repair (from the GRASP Registry). Am J Cardiol, 2013, 111(10): 1482-1487.
17. Nickenig G, Estevez-Loureiro R, Franzen O, et al. Percutaneous mitral valve edge-to-edge repair: in-hospital results and 1-year follow-up of 628 patients of the 2011-2012 Pilot European Sentinel Registry. J Am Coll Cardiol, 2014, 64(9): 875-884.
18. Bonow RO, Carabello B, de Leon AC, et al. ACC/AHA guidelines for the management of patients with valvular heart disease. Executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease). J Heart Valve Dis, 1998, 7(6): 672-707.
19. Stone GW, Lindenfeld J, Abraham WT, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med, 2018, 379(24): 2307-2318.
20. Bavry AA, Arnaoutakis GJ. Perspective to 2020 American College of Cardiology/American Heart Association (ACC/AHA) guideline for the management of patients with valvular heart disease. Circulation, 2021, 143(5): 407-409.
21. Feldman T, Foster E, Glower DD, et al. Percutaneous repair or surgery for mitral regurgitation. N Engl J Med, 2011, 364(15): 1395-1406.
22. Liu XH, Shi JY, Feng XJ, et al. Short-term and 1-year outcomes after MitraClip therapy in functional versus degenerative mitral regurgitation patients: a systematic review and meta-analysis. J Thorac Dis, 2018, 10(7): 4156-4168.
23. Chiarito M, Pagnesi M, Martino EA, et al. Outcome after percutaneous edge-to-edge mitral repair for functional and degenerative mitral regurgitation: a systematic review and meta-analysis. Heart, 2018, 104(4): 306-312.
24. Cota GF, de Sousa MR, Fereguetti TO, et al. Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIV infected patients: a systematic review with indirect comparison. PLoS Negl Trop Dis, 2013, 7(5): e2195.
25. Henández-Vaquero D, Pascual I, Almendarez M, et al. Initial experience of a MitraClip valve repair program in Spain. Ann Transl Med, 2020, 8(15): 957.
26. Kar S, von Bardeleben RS, Rottbauer W, et al. Contemporary outcomes following transcatheter edge-to-edge repair: 1-year results from the EXPAND study. JACC Cardiovasc Interv, 2023, 16(5): 589-602.
27. Kheifets M, Angelini F, D'Ascenzo F, et al. Outcomes of transcatheter edge-to-edge repair in degenerative vs. functional mitral regurgitation. J Clin Med, 2022, 11(20): 6010.
28. Mantegazza V, Pasquini A, Agati L, et al. Comprehensive assessment of mitral valve geometry and cardiac remodeling with 3-dimensional echocardiography after percutaneous mitral valve repair. Am J Cardiol, 2018, 122(7): 1195-1203.
29. ?ztürk C, Friederich M, Werner N, et al. Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve. Cardiol J, 2021, 28(2): 215-222.
30. Pascual I, Arzamendi D, Carrasco-Chinchilla F, et al. Transcatheter mitral repair according to the cause of mitral regurgitation: real-life data from the Spanish MitraClip registry. Rev Esp Cardiol (Engl Ed), 2020, 73(8): 643-651.
31. Patzelt J, Zhang W, Sauter R, et al. Elevated mitral valve pressure gradient is predictive of long-term outcome after percutaneous edge-to-edge mitral valve repair in patients with degenerative mitral regurgitation (MR), but not in functional MR. J Am Heart Assoc, 2019, 8(13): e011366.
32. Perl L, Kheifets M, Guido A, et al. Acute reduction in left ventricular function following transcatheter mitral edge-to-edge repair. J Am Heart Assoc, 2023, 12(13): e029735.
33. Rudolph V, Lubos E, Schlüter M, et al. Aetiology of mitral regurgitation differentially affects 2-year adverse outcomes after MitraClip therapy in high-risk patients. Eur J Heart Fail, 2013, 15(7): 796-807.
34. Schueler R, Kaplan S, Melzer C, et al. Impact of interventional edge-to-edge repair on mitral valve geometry. Int J Cardiol, 2017, 230: 468-475.
35. Seeger J, Müller P, Gonska B, et al. Percutaneous mitral valve repair with the MitraClip in primary compared with secondary mitral valve regurgitation using the mitral valve academic research consortium criteria. J Invas Cardiol, 2017, 29(4): 145-50.
36. Yoon SH, Makar M, Kar S, et al. Outcomes after transcatheter edge-to-edge mitral valve repair according to mitral regurgitation etiology and cardiac remodeling. JACC Cardiovasc Interv, 2022, 15(17): 1711-1722.
37. Goliasch G, Bartko PE, Pavo N, et al. Refining the prognostic impact of functional mitral regurgitation in chronic heart failure. Eur Heart J, 2018, 39(1): 39-46.
38. Mack MJ, Lindenfeld J, Abraham WT, et al. 3-year outcomes of transcatheter mitral valve repair in patients with heart failure. J Am Coll Cardiol, 2021, 77(8): 1029-1040.
39. Yeo KK, Yap J, Yamen E, et al. Percutaneous mitral valve repair with the MitraClip: early results from the MitraClip Asia-Pacific Registry (MARS). EuroIntervention, 2014, 10(5): 620-625.
40. Tay E, Muda N, Yap J, et al. The MitraClip Asia-Pacific Registry: differences in outcomes between functional and degenerative mitral regurgitation. Catheter Cardiovasc Interv, 2016, 87(7): E275-281.
41. Franzen O, van der Heyden J, Baldus S, et al. MitraClip? therapy in patients with end-stage systolic heart failure. Eur J Heart Fail, 2011, 13(5): 569-576.
42. He S, Fontaine AA, Schwammenthal E, et al. Integrated mechanism for functional mitral regurgitation: leaflet restriction versus coapting force: in vitro studies. Circulation, 1997, 96(6): 1826-1834.
43. He S, Lemmon JD Jr, Weston MW, et al. Mitral valve compensation for annular dilatation: in vitro study into the mechanisms of functional mitral regurgitation with an adjustable annulus model. J Heart Valve Dis, 1999, 8(3): 294-302.
44. Kono T, Sabbah HN, Rosman H, et al. Left ventricular shape is the primary determinant of functional mitral regurgitation in heart failure. J Am Coll Cardiol, 1992, 20(7): 1594-1598.
45. Raposeiras-Roubin S, Adamo M, Freixa X, et al. A score to assess mortality after percutaneous mitral valve repair. J Am Coll Cardiol, 2022, 79(6): 562-573.
46. Eggebrecht H, Schelle S, Puls M, et al. Risk and outcomes of complications during and after MitraClip implantation: experience in 828 patients from the German TRAnscatheter mitral valve interventions (TRAMI) registry. Catheter Cardiovasc Interv, 2015, 86(4): 728-735.
47. 荊朝輝, 榮曉松, 焦國慶, 等. 合并重度肺動脈高壓的二尖瓣疾病行二尖瓣置換術的安全性. 國際心血管病雜志, 2024, 51(1): 62-64.Jing ZH, Rong XS, Jiao GQ, et al. Safety of mitral valve replacement for mitral valve disease complicated with severe pulmonary hypertension. Int J Cardiovasc Dis, 2024, 51(1): 62-64.
48. Chan KL, Chen SY, Chan V, et al. Functional significance of elevated mitral gradients after repair for degenerative mitral regurgitation. Circ Cardiovasc Imaging, 2013, 6(6): 1041-1047.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy of MitraClip in functional versus degenerative mitral regurgitation: A systematic review and meta-analysis

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