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July 8, 2026The Cardiothoracic SurgeonOpen Access

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

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Key result

Mitral surgery after failed M-TEER is linked to ~12% early mortality, predominantly involving valve replacement.

  • 11.7%
  • 95% CI 8.4-16.0
  • n=951

Why the study?

Pooled early all-cause mortality and feasibility of surgical repair after failed MitraClip or transcatheter edge-to-edge repair had not been reliably estimated across the retrospective evidence base.

Population

951 adults across 8 unique surgical cohorts undergoing mitral surgery after failed MitraClip/TEER

Design

Systematic review and single-arm meta-analysis

Follow-up

Operative, in-hospital, or 30 days

Authors

ACAlberto CampaillaUniversity of ParmaRLRoberto LorussoMaastricht University Medical CentreAAAndrea AgostinelliUniversity of Parma

Discussion

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Implication

Substantial early mortality after surgery for failed TEER warrants caution in referral decisions; leaves open optimal strategy versus alternatives pending prospective data.

Key Points

  • To estimate early all-cause mortality post-mitral surgery for failed transcatheter edge-to-edge repair, considering evidence limitations.
  • Systematic review and meta-analysis following PRISMA guidelines.
  • Data from MEDLINE, Embase, Scopus, and Web of Science until January 2026; included retrospective studies with mortality data post-MitraClip failure.
  • Pooled proportions assessed using random-effects meta-analysis, with sensitivity analyses for endpoint homogeneity.
  • Pooled early mortality estimate of 11.7% (95% CI: 8.4–16.0%; I2 = 39.2%).
  • Operative-only mortality: 9.5%, in-hospital-only mortality: 11.9%, 30-day-only mortality: 15.3%.
  • Pooled surgical repair rate of 12.5% (95% CI: 6.1–24.1%), indicating considerable heterogeneity (I2 = 85.1%).

Study Design

Type

Meta-Analysis (n=951)

Structured PICO

P
Population
951 adult patients undergoing mitral surgery after failed transcatheter edge-to-edge repair across 8 retrospective cohorts, assessed for early mortality.
I
Intervention
Mitral surgery (repair or replacement) after failed MitraClip/TEER
O
Outcome
Early all-cause mortality (defined as operative, in-hospital, and/or 30-day mortality)hard clinical

Main Result

Effect estimate: 11.7% (95% CI 8.4-16.0)

Mitral surgery after failed transcatheter edge-to-edge repair is associated with substantial early mortality (11.7%) and low repair feasibility (12.5%), with valve replacement remaining the predominant strategy.

Limitations

  • Evidence is entirely retrospective and observational with high risk of bias
  • Absence of prospective protocol registration
  • Endpoint definitions varied between operative, in-hospital, and 30-day mortality
  • Residual overlap between institutional and registry reports cannot be completely excluded
  • Important confounders were not consistently reported and could not be adjusted for
  • Repair-versus-replacement comparisons are confounded by indication
  • No patient-level data were available
  • Retrospective case series/registries with high risk of bias
  • No adjustment for confounders
  • Heterogeneous endpoint definitions
  • Underpowered for formal publication-bias testing

Cite This Study

Campailla et al. (2026) conducted a meta-analysis in Failed MitraClip/TEER requiring mitral surgery (n=951). Mitral surgery after failed M-TEER was evaluated on Early all-cause mortality (mixed-definition: operative, in-hospital, or 30-day) (11.7%, 95% CI 8.4-16.0). Mitral surgery after failed transcatheter edge-to-edge repair is associated with a pooled early all-cause mortality of 11.7%, with valve replacement remaining the predominant surgical strategy.

synapsesocial.com/papers/6a4de9e4d2ea289ef6283e97https://doi.org/10.1186/s43057-026-00212-5
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Surgical revision after percutaneous mitral valve repair by edge-to-edge device: when the strategy fails in the highest risk surgical population2013 · 43 citations
  2. 2Mitral Valve Surgery After Failed MitraClip: A Single-Center Experience2021 · 10 citations
  3. 3Mitral Valve Surgery in 6 Patients after Failed MitraClip Therapy2014 · 24 citations
  4. 4Mitral valve surgery after a failed MitraClip procedure2020 · 27 citations
  5. 5Mitral valve surgery after failed transcatheter intervention for mitral regurgitation: surgical techniques, challenges and outcomes2025 · 5 citations