Comparison of Meta-Analytical Estimates Between Surgical Repair and Transcatheter Edge-to-Edge Repair for Atrial Functional Mitral Regurgitation

Q: What clinical problem does the study address?

Atrial functional mitral regurgitation (AFMR) lacks well-defined treatment guidelines, and medical therapy alone is insufficient.

Q: Which treatments were compared in the meta-analysis?

Surgical repair was compared with transcatheter edge-to-edge repair (TEER), including isolated transcatheter approaches.

Q: What did the study find about long-term outcomes?

Surgery was associated with lower rates of late severe MR, late all-cause mortality, and late heart failure hospitalization, but better long-term results showed high heterogeneity and require prospective validation.

Sep 29, 2026

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Atrial functional mitral regurgitation (MR) has limited treatment guidance, and medical therapy alone is inadequate. A meta-analysis compared surgical repair versus transcatheter edge-to-edge repair (TEER) using MEDLINE, EMBASE, and Cochrane Library data, with late severe MR as the primary outcome. Thirty-two studies (1923 patients) were included, showing surgery reduced late severe MR and several adverse outcomes, while early mortality and many morbidities were comparable. Findings showed substantial heterogeneity and require prospective validation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

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Interdisciplinary CardioVascular and Thoracic Surgery 2026, 41(1), ivaf269 META-ANALYSIS [https://doi.org/10.1093/icvts/ivaf269](https://doi.org/10.1093/icvts/ivaf269) Advance Access publication 24 December 2025 Cite this article as: Khairallah S, Rahouma M, Demetres M, Girardi L, Gaudino M, Hirofuji A et al. Comparison of Meta-Analytical Estimates Between Surgical Repair and Transcatheter Edge-to-Edge Repair for Atrial Functional Mitral Regurgitation. Interdiscip CardioVasc Thorac Surg 2026; doi:10.1093/icvts/ivaf269. Comparison of Meta-Analytical Estimates Between Surgical Repair and Transcatheter Edge-to-Edge Repair for Atrial Functional Mitral Regurgitation Sherif Khairallah 􀀃 ,1,2; Mohamed Rahouma1,2; Michelle Demetres 3; Leonardo Girardi1; Mario Gaudino1; Aina Hirofuji1; Mark Reisman4; Stephanie L. Mick1 1Cardiothoracic Surgery Department, Weill Cornell Medicine (WCM), New York-Presbyterian Hospital, New York, NY 10065, United States 2Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, 11796, Egypt 3Weill Cornell Medicine (WCM), Samuel J. Wood Library & C.V. Starr Biomedical Information Center, New York, NY, 10065, USA 4Structural Heart Program, Weill Cornell Medical Center, New York, NY, 10065, USA 􀀃 Corresponding author. Cardiothoracic Surgery Department, Weill Cornell Medicine (WCM), New York-Presbyterian Hospital, 525 East 68th Street, Suite M404, New York, NY 10065, United States ([smk4005@med.cornell.edu](smk4005@med.cornell.edu)). Received: February 28, 2025; Revised: April 27, 2025; Accepted: October 18, 2025 Graphical abstract VALVU LAR HEART DISEASE Abstract OBJECTIVES: Atrial functional mitral regurgitation (MR) lacks well-defined treatment guidelines. Medical therapy alone is insufficient, and either TEER (transcatheter edge-to-edge) or surgery is recommended. Short-and long-term comparative outcomes remain unclear. We aim to address this gap using available data. Author Contributions: S. Khairallah and M. Rahouma contributed equally to this work. © The Author(s) 2025. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. 2 Interdisciplinary CardioVascular and Thoracic Surgery, 2026, Volume 41, Issue 1 METHODS: We performed a meta-analysis of studies examining the outcomes of surgery and/or transcatheter edge-to-edge. MEDLINE, EMBASE, and the Cochrane Library were assessed. The incidence rate of late severe MR was the primary outcome. A random model was performed. Leave-one-out, subgroup, and meta-regression analyses were conducted. RESULTS: Thirty-two studies (1923 patients); 20 in surgery (1166) vs 12 in TEER (757), were selected. TEER patients were, on average, 10 years older, with twice the rate of New York Heart Association Classification (NYHA) III/IV symptoms and more than double the Society of Thoracic Surgeons Risk (STS) score. At a weighted mean follow-up of 3.2 years, compared to isolated transcatheter, surgery was associated with decreased incidence of late severe MR (2.53 vs 6.66 events per 100 person-years, P-interaction ¼ .03), late all-cause mortality (3.00 vs 8.84, P-interaction ¼ .024), late heart failure hospitalization (4.44 vs 17.03, P-interaction < .01), and late NYHA III/IV (2.98 vs 22.47, P-interaction < .01). However, significantly better long-term outcomes associated with surgery showed high heterogeneity. There were no differences in early all-cause mortality, early cardiac-specific mortality, late cardiac-specific mortality, postprocedural morbidities, or atrial diameter. On meta-regression, preprocedural heart failure (β ¼ 0.0224, P < .01) and

FAQs

What clinical problem does the study address?

Atrial functional mitral regurgitation (AFMR) lacks well-defined treatment guidelines, and medical therapy alone is insufficient.

Which treatments were compared in the meta-analysis?

Surgical repair was compared with transcatheter edge-to-edge repair (TEER), including isolated transcatheter approaches.

What did the study find about long-term outcomes?

Surgery was associated with lower rates of late severe MR, late all-cause mortality, and late heart failure hospitalization, but better long-term results showed high heterogeneity and require prospective validation.

Sep 29, 2026

Upload by ahduag