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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?

What is the early mortality rate in adults undergoing mitral surgery after failed MitraClip/TEER?

Population

Adults undergoing mitral surgery after failed MitraClip/TEER (8 unique surgical cohorts, N=951)

Design

Meta-analysis

Follow-up

Early (operative, in-hospital, or 30-day)

Authors

ACAlberto CampaillaRLRoberto LorussoAAAndrea Agostinelli

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

What is the early mortality rate in adults undergoing mitral surgery after failed MitraClip/TEER?

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 after failed transcatheter edge-to-edge repair (M-TEER)
O
Outcome
Early all-cause mortality (operative, in-hospital, or 30-day mortality)hard clinical

Main Result

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

Mitral surgery after failed M-TEER is associated with substantial early mortality (11.7%), with valve replacement being the predominant strategy and repair feasible in only a minority of patients.

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
  • Derived entirely from retrospective case series/registries with high risk of bias
  • No adjustment for confounders
  • Heterogeneous endpoint definitions

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. 1Comparing mitral transcatheter edge-to-edge repair and surgical intervention in mitral regurgitation: A meta-analysis2026
  2. 2MitraClip Versus Surgery for Secondary Mitral Regurgitation: A Systematic Review and Updated Meta‐Analysis2025 · 1 citations
  3. 3Functional mitral valve regurgitation outcomes by treatment modality: a systematic review and meta-analysis of reconstructed survival data2026
  4. 4Comparison of meta-analytical estimates between surgical repair and transcatheter edge-to-edge repair for atrial functional mitral regurgitation2025 · 1 citations
  5. 5Long-term effect of transcatheter mitral valve edge-to-edge repair on left ventricular function and mitral regurgitation severity: a single-center experience2025 · 1 citations