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Mitral Valve Surgery After Failed Transcatheter Edge-to-Edge Repair: A Meta-Analysis
Francesco Cabrucci1, Massimo Baudo1, Dimitrios E Magouliotis2
1Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA.
The Canadian Journal of Cardiology
|February 13, 2025
Summary
Surgery after failed transcatheter edge-to-edge repair (TEER) for mitral regurgitation is challenging but feasible. Outcomes are acceptable, especially for elective procedures, with predictors including comorbidities and left ventricle function.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Device Technology
Background:
- Transcatheter edge-to-edge repair (TEER) is a growing treatment for mitral regurgitation (MR), especially in high-risk patients.
- Failure of TEER necessitates mitral valve surgery, which poses significant challenges due to patient comorbidities.
Purpose of the Study:
- To evaluate the short- and long-term surgical outcomes following failed TEER for MR.
- To identify predictors of mortality after mitral valve surgery post-TEER failure.
Main Methods:
- Meta-analysis of observational studies reporting outcomes of mitral valve surgery after TEER failure.
- Multivariable meta-regressions to predict mortality; Kaplan-Meier function reconstruction for survival analysis.
Main Results:
- 16 studies with 892 patients (mean age 74.8 years) undergoing surgery after TEER failure.
- 30-day mortality was 12.2% (2.5% for elective cases); 14.7-month follow-up mortality was 28.3%.
- Predictors of adverse outcomes included coronary artery disease, lower LVEF, concomitant procedures, and functional MR.
Conclusions:
- Mitral valve surgery after TEER failure is challenging but achievable, with better outcomes in elective settings.
- Preserved LVEF and complete treatment of concomitant lesions may improve results.
- Future research should differentiate outcomes by surgery timing (elective vs. emergent) and MR etiology.
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