Transcatheter Mitral Valve Repair for Failed Surgical Mitral Valve Repair: A Systematic Review and Meta-Analysis

Objectives: To assess the outcomes of transcatheter mitral valve repair (TMVr) for failed previous surgical mitral valve repair (MVr). Methods: We searched Pubmed, Embase, and Cochrane Library databases for studies that reported the outcomes of TMVr for failed initial surgical MVr. Data were extracted by 2 independent investigators and subjected to meta-analysis. The 95% confidence interval (CI) was calculated for preoperative demographics, peri-operative outcomes, and follow-up outcomes using binary and continuous data from single-arm studies. Results: Eight single-arm studies were included, with a total of 212 patients, and mean follow-up ranged from 1.0 to 15.9 months. The pooled rate of residual procedural mitral regurgitation ≤mild was 76% (95% CI: 67%~84%; I2 = 0%; 7 studies, 199 patients). During follow-up, mitral regurgitation ≤mild was found in 68% of patients (95% CI: 52%~82%; I2 = 57%; 6 studies, 147 patients). Follow-up survival was 94% (95% CI: 88%~98%; I2 = 0%; 7 studies, 196 patients). 83% patients (95% CI: 75%~89%; I2 = 47%; 6 studies, 148 patients) were in NYHA class I or II. Conclusions: TMVr for failed surgical MVr was safe and effective, which should be recommended in selected patients if technically feasible.