Combined M-TEER and LAAO resulted in similar procedural success (RR 0.91; 95% CI 0.71-1.17) and all-cause death (RR 0.59; 95% CI 0.22-1.54) compared to M-TEER alone.
Meta-Analysis (n=223)
Does combining M-TEER and LAAO in one procedure improve procedural outcomes and safety compared to M-TEER alone in patients with atrial fibrillation and mitral regurgitation?
Combining M-TEER and LAAO into a single procedure yields similar procedural success to M-TEER alone, though further research is needed to clarify the risk of peri-procedural complications.
Relative Risk: 0.91 (95% CI 0.71–1.17)
Background/Objectives: Patients with atrial fibrillation and mitral regurgitation (MR) undergoing transcatheter edge-to-edge mitral valve repair (M-TEER) often have concomitant indications for left atrial appendage occlusion (LAAO), mandating a more personalized treatment approach. This study aimed to examine the effectiveness and safety of combining M-TEER/LAAO in one procedure. Methods: MEDLINE (PubMed), Scopus, and Cochrane were searched through 21 March 2025 for studies examining M-TEER/LAAO with or without control (M-TEER only). Double-independent study selection, extraction, and quality assessments were performed. Frequentist random-effects models were used to calculate mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs). Results: Seven studies (223 participants) were included. For M-TEER/LAAO, the mean procedural time was 101.6 min (95% CI = 85.06, 118.13), the mean radiation time was 29.97 min (95% CI = 23.85, 36.09), the mean length of stay was 5.21 days (95% CI = 3.31, 7.12), procedural success was achieved in 89.5% of cases (95% CI = 73.4, 96.3, and post-procedure MR > 2+ occurred in 14.8% of cases (95% CI = 3.6, 44.5). Compared to M-TEER only, patients with M-TEER/LAAO had similar procedural (RR = 0.91, 95% CI = 0.71, 1.17) and technical success (RR = 1, 95% CI = 0.94, 1.06) with a similar risk of acute kidney injury (RR = 1, 95% CI = 0.07, 15.12), bleeding (RR = 0.40, 95% CI = 0.01, 18.06), and all-cause death (RR = 0.59, 95% CI = 0.22, 1.54). M-TEER/LAAO was non-significantly associated with in-hospital death (RR = 3, 95% CI = 0.13, 70.23), stroke (RR = 3, 95% CI = 0.13, 70.23), and vascular complications (RR = 1.55, 95% CI = 0.43, 5.59) compared to M-TEER only. Most patients (34.2%, 95% CI = 2.8, 90.4) received dual antiplatelet therapy at discharge, followed by anticoagulation only (20.2%, 95% CI = 7.5, 44.3). Conclusions: M-TEER/LAAO can be combined into a single procedure with good peri-procedural outcomes. Safety was also satisfactory; however, some concerns may arise regarding in-hospital death, stroke, and vascular complications. Further research is needed to explore the effectiveness and safety of this combined strategy and elucidate the risk–benefit profile of this personalized treatment approach.
Pamporis et al. (Wed,) conducted a meta-analysis in Atrial fibrillation and mitral regurgitation (n=223). Combined M-TEER and LAAO vs. M-TEER only was evaluated on Procedural success (RR 0.91, 95% CI 0.71, 1.17). Combined M-TEER and LAAO resulted in similar procedural success (RR 0.91; 95% CI 0.71-1.17) and all-cause death (RR 0.59; 95% CI 0.22-1.54) compared to M-TEER alone.
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