Prophylactic Left Atrial Appendage Occlusion During Mitral Valve Repair in Patients Without Atral Fibrillation: A Meta‐Analysis of Time to Event Data

Background Mitral valve repair (MVr) is effective for mitral regurgitation, but the benefit of prophylactic left atrial appendage occlusion (LAAO) in patients without prior atrial fibrillation (AF) remains unclear. This meta‐analysis aimed to assess the long‐term safety and efficacy of LAAO in this understudied population. Methods We performed a meta‐analysis from four major databases until December 2025. Kaplan–Meier curves data were reconstructed and analyzed using Cox regression models and hazard ratios (HR) for thromboembolic events (mainly stroke). A random‐effects meta‐analysis was performed with R software to calculate risk ratios (RR), hazard ratios (HR), and mean differences (MD), all with 95% confidence intervals (CIs). Results Three studies with 5048 patients were included. LAAO was associated with a significant reduction in thromboembolic risk at 5 years (HR 0.60, 95% CI 0.46 to 0.77). LAAO reduced in‐hospital stroke (RR 0.43, 95% CI 0.25 to 0.72) but increased postoperative AF (RR 1.17, 95% CI 1.09 to 1.26). No significant differences were observed in 30‐day mortality (RR 0.56, 95% CI 0.07 to 4.33) or hospital stay (MD –0.16 days, 95% CI – 0.48 to 0.16). Conclusions Prophylactic LAAO during MVr in patients without AF may reduce thromboembolic events risk but appears to increase postoperative AF. Further randomized studies are warranted.