Outcomes of transcatheter edge-to-edge repair in patients with previous transcatheter aortic valve replacement: a systematic review and meta-analysis

Abstract Background Coexisting mitral regurgitation (MR) is a frequent finding in patients undergoing transcatheter aortic valve replacement (TAVR) for aortic diseases. Surgical repair remains the leading option for the majority of MR patients. However, for those with high or prohibitive surgical risk, catheter-based interventions are considered an alternative solution. While the use of transcatheter edge-to-edge repair (TEER) is expanding in clinical settings, its application remains challenging due to anatomical complexities, such as broad leaflet structures, subvalvular pathology, and left ventricular remodeling. Purpose Given the limited data on the safety, efficacy, and feasibility of TEER in patients with prior TAVR, we aim to provide a comprehensive analysis of clinical outcomes and associated complications in this population. Methods We conducted a systematic review and meta-analysis across PubMed, Scopus, Embase, and the Cochrane Central Register of Controlled Trials up to December 2024. Studies investigating TEER outcomes in patients with prior TAVR were included. The primary outcomes were in-hospital, cardiovascular, and all-cause mortality. Secondary outcomes included the incidence of acute kidney injury (AKI), stroke, bleeding, length of stay (LOS), rehospitalization rates, and changes in New York Heart Association (NYHA) functional class and MR grade after TEER. The cumulative incidence and 95% confidence intervals (CIs) were calculated. A random-effects model was performed to assess heterogeneity using I². All statistical analyses were performed using Comprehensive Meta-Analysis Software (CMA). Results Six studies with 650 patients (428 males, 222 females) who underwent TEER after TAVR were included in the analysis. The results revealed a cumulative incidence of 1.9% 95% CI: 0.8–4.3 for in-hospital mortality, 20.1% 95% CI: 9.4–38 for cardiovascular mortality, and 16% 95% CI: 5.3–39.3 for all-cause mortality. Additionally, 7.8% 95% CI: 3.4–17.1 of patients experienced AKI, while 1.5% 95% CI: 0.6–4.1 developed stroke/TIA during their hospital stay. Bleeding complications were occurred in 10.9% 95% CI: 4.2–25.6, and the mean LOS was 3.86 ± 0.61 days Mean ± Standard Error, with 31.9% 95% CI: 28–36.1 of patients being rehospitalized. Across all included studies, TEER was associated with a significant improvement in both NYHA functional class and MR grade. Conclusion Given the complexity of multivalve disease, our meta-analysis supports the feasibility and safety of TEER for managing MR in TAVR patients, offering a viable alternative for those unsuitable for traditional surgical interventions and demonstrating significant improvements in cardiac function. However, larger prospective studies are needed to further validate its feasibility and safety.NYHA and MR Grade Change