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Objectives <p>To estimate pooled early all-cause mortality after mitral surgery for failed transcatheter edge-to-edge repair (M-TEER) and, as an exploratory objective, to describe the feasibility of surgical repair while explicitly accounting for the limitations of the retrospective evidence base.</p> Methods <p>This systematic review and meta-analysis followed PRISMA 2020. MEDLINE, Embase, Scopus, and Web of Science were searched from inception to 8 January 2026, with reference-list screening. Eligible studies included adults undergoing mitral surgery after failed MitraClip/TEER and reporting extractable operative, in-hospital, or 30-day mortality. Reports with likely overlapping cohorts were adjudicated, and the most informative dataset was retained for the main analytic set. Pooled proportions were estimated using random-effects single-arm meta-analysis with logit transformation, with endpoint-homogeneous and small-study sensitivity analyses. Certainty of evidence was assessed using GRADE. The pooled estimates are derived entirely from retrospective case series/registries with high risk of bias and no adjustment for confounders; they should not be used for individual risk prediction without center-specific validation.</p> Results <p>Fifteen full-text reports were identified; one was excluded for insufficient sample size. Fourteen studies entered the qualitative synthesis, and 8 unique surgical cohorts (<i>N</i> = 951) formed the main analytic set after overlap adjudication. The pooled mixed-definition early mortality was 11.7% (95% CI: 8.4–16.0%; I2 = 39.2%; 95% prediction interval: 5.5–23.1%). Endpoint-homogeneous analyses were directionally consistent but underpowered: operative-only mortality 9.5%, in-hospital-only mortality 11.9%, and 30-day-only mortality 15.3%. The pooled repair rate was 12.5% (95% CI: 6.1–24.1%), with considerable heterogeneity (I2 = 85.1%) and a prediction interval of 1.1–64.4%. Certainty of evidence was very low for both outcomes.</p> Conclusions <p>Mitral surgery after failed M-TEER is associated with substantial early mortality in the published retrospective literature, but the pooled estimate is crude, unadjusted, and based on heterogeneous endpoint definitions. Valve replacement remains the predominant surgical strategy. Surgical repair is reported in a minority of patients and should be interpreted as an exploratory, center- and anatomy-dependent outcome rather than as a generalizable probability. These estimates should not be used for individual risk prediction without center-specific validation.</p>

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Early mortality after mitral surgery for failed MitraClip/TEER: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月6日

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  • Alberto Campailla,
  • Roberto Lorusso,
  • Andrea Agostinelli,
  • Filippo Benassi,
  • Rocco Oliva,
  • Giulia Grassa,
  • Francesco Nicolini,
  • Davide Carino

摘要

Objectives

To estimate pooled early all-cause mortality after mitral surgery for failed transcatheter edge-to-edge repair (M-TEER) and, as an exploratory objective, to describe the feasibility of surgical repair while explicitly accounting for the limitations of the retrospective evidence base.

Methods

This systematic review and meta-analysis followed PRISMA 2020. MEDLINE, Embase, Scopus, and Web of Science were searched from inception to 8 January 2026, with reference-list screening. Eligible studies included adults undergoing mitral surgery after failed MitraClip/TEER and reporting extractable operative, in-hospital, or 30-day mortality. Reports with likely overlapping cohorts were adjudicated, and the most informative dataset was retained for the main analytic set. Pooled proportions were estimated using random-effects single-arm meta-analysis with logit transformation, with endpoint-homogeneous and small-study sensitivity analyses. Certainty of evidence was assessed using GRADE. The pooled estimates are derived entirely from retrospective case series/registries with high risk of bias and no adjustment for confounders; they should not be used for individual risk prediction without center-specific validation.

Results

Fifteen full-text reports were identified; one was excluded for insufficient sample size. Fourteen studies entered the qualitative synthesis, and 8 unique surgical cohorts (N = 951) formed the main analytic set after overlap adjudication. The pooled mixed-definition early mortality was 11.7% (95% CI: 8.4–16.0%; I2 = 39.2%; 95% prediction interval: 5.5–23.1%). Endpoint-homogeneous analyses were directionally consistent but underpowered: operative-only mortality 9.5%, in-hospital-only mortality 11.9%, and 30-day-only mortality 15.3%. The pooled repair rate was 12.5% (95% CI: 6.1–24.1%), with considerable heterogeneity (I2 = 85.1%) and a prediction interval of 1.1–64.4%. Certainty of evidence was very low for both outcomes.

Conclusions

Mitral surgery after failed M-TEER is associated with substantial early mortality in the published retrospective literature, but the pooled estimate is crude, unadjusted, and based on heterogeneous endpoint definitions. Valve replacement remains the predominant surgical strategy. Surgical repair is reported in a minority of patients and should be interpreted as an exploratory, center- and anatomy-dependent outcome rather than as a generalizable probability. These estimates should not be used for individual risk prediction without center-specific validation.