B-56 | Impact of Persistent Iatrogenic Atrial Septal Defect Following Transcatheter Mitral Valve Repair: A Meta-Analysis

Long-term outcomes in patients with persistent iatrogenic atrial septal defect (iASD) after transcatheter mitral valve intervention (TMVR) have not been thoroughly explored. Our meta-analysis focuses on investigating the cardiovascular outcomes in this population. A systematic literature search of PubMed/MEDLINE and Google Scholar was performed (2005 - 2023) to identify studies reporting cardiovascular outcomes in patients with persistent iASD following TMVR. Odds of major adverse cardiovascular and cerebrovascular event (MACCE), mortality, heart failure hospitalizations (HFH) and stroke were calculated using a random-effects model. Heterogeneity was assessed using the I2 statistics. Leave one out method was used for sensitivity analysis. A p value < 0.05 was considered statistically significant. Of the six studies included in the final meta-analysis, 854 (iASD=257, no iASD 597) had undergone TMVR (61.6% males, mean age 76.8 years, mean follow up duration 19.7 months). Patients with persistent iASD had a significantly higher MACCE events (aOR 4.23, CI 1.27-14.15, p=0.02), HFH (aOR 3.61, CI 1.77 - 7.34, p<0.01), and trend towards increased mortality (aOR 1.41, CI 0.75 - 2.67, p=0.41). However, there was no association between stroke (aOR 0.81, 95% CI 0.35-1.90, p=0.63). (Figure 1) We found higher rates of MACCE, HFH, and trend towards increased mortality. Patients with persisting iASD post-MVR had no association with stroke at 19 months. Prospective studies on events after iASD closure are required to understand etiology and long-term cardiovascular consequences.