Iatrogenic atrial septal defect following transcatheter edge-to-edge mitral valve repair: A systematic review and meta-analysis.

BACKGROUND: Transcatheter edge-to-edge mitral valve repair (TEER) requires transseptal access of the left atrium, which usually causes an iatrogenic atrial septal defect (iASD). It is controversial that whether these patients with iASD persistence will progress to a bad prognostic state. So it's worthwhile to evaluate whether the procedure of TEER induced iASD leads to development of a relevant interatrial shunt. This systematic review and meta-analysis aimed to identify predictors of iASD persistence in patients with mitral regurgitation (MR) undergoing TEER and assess its effect on in-hospital outcomes and mortality. METHODS: In this systematic review and meta-analysis, we conducted a literature search in various databases. Our investigation summarized data from contemporary studies on the incidence of iASD following TEER for MR and its association with clinical outcomes. RESULTS: 10 studies were analyzed, possible predictors of risk factors for the persistence of iASD after TEER seemed to be atrial fibrillation before surgery (OR 1.40; P = .04), residual MR > 2+(OR 2.36; P = .001), residual tricuspid regurgitation > mild(OR 1.52; P = .01), and prolonged fluoroscopic time(MD [in minutes] 5.36; P = .007). Patients with iASD persistence after TEER seemed to have a greater risk to suffer from right heart overload reflecting from the enlarged right ventricle end-diastolic dimension (RVEDD) (MD 3.27; P < .00001) and the enlarged diameter of the right atrium (MD 4.41; P < .00001). Patients with iASD persistence after TEER had a greater risk of heart failure rehospitalization (OR 2.71; P = .003). CONCLUSION: This systematic review and meta-analysis identified several related predictors of iASD persistence, possibly leading to right heart volume overload and a higher risk of heart failure rehospitalization. In order to generalize our findings, larger clinical studies in independent patient cohorts are necessary. What's more, there is a need to perform a careful decision for interventional closure of an iASD after TEER.