{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T13:31:06Z","timestamp":1776173466004,"version":"3.50.1"},"reference-count":66,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>OBJECTIVES<\/jats:title>\n                    <jats:p>Atrial functional mitral regurgitation (MR) lacks well-defined treatment guidelines. Medical therapy alone is insufficient, and either TEER (transcatheter edge-to-edge) or surgery is recommended. Short- and long-term comparative outcomes remain unclear. We aim to address this gap using available data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We performed a meta-analysis of studies examining the outcomes of surgery and\/or transcatheter edge-to-edge. MEDLINE, EMBASE, and the Cochrane Library were assessed. The incidence rate of late severe MR was the primary outcome. A random model was performed. Leave-one-out, subgroup, and meta-regression analyses were conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Thirty-two studies (1923 patients); 20 in surgery (1166) vs 12 in TEER (757), were selected. TEER patients were, on average, 10 years older, with twice the rate of New York Heart Association Classification (NYHA) III\/IV symptoms and more than double the Society of Thoracic Surgeons Risk (STS) score. At a weighted mean follow-up of 3.2 years, compared to isolated transcatheter, surgery was associated with decreased incidence of late severe MR (2.53 vs 6.66 events per 100 person-years, P-interaction\u2009=\u2009.03), late all-cause mortality (3.00 vs 8.84, P-interaction\u2009=\u2009.024), late heart failure hospitalization (4.44 vs 17.03, P-interaction &amp;lt; .01), and late NYHA III\/IV (2.98 vs 22.47, P-interaction &amp;lt; .01). However, significantly better long-term outcomes associated with surgery showed high heterogeneity. There were no differences in early all-cause mortality, early cardiac-specific mortality, late cardiac-specific mortality, postprocedural morbidities, or atrial diameter. On meta-regression, preprocedural heart failure (\u03b2\u2009=\u20090.0224, P\u2009&amp;lt;\u2009.01) and coronary artery disease (\u03b2\u2009=\u20090.0294, P\u2009&amp;lt;\u2009.00001) were linked to increased late severe MR. Older age, hypertension, mitral valve replacement, and associated aortic valve surgery were linked to increased late all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Surgery and isolated transcatheter edge-to-edge repair showed comparable short-term outcomes, with surgery appearing more effective long-term; however, due to study limitations and heterogeneity, these findings are hypothesis-generating and require validation through prospective studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CLINICAL REGISTRATION NUMBER<\/jats:title>\n                    <jats:p>PROSPERO website: CRD42024504022.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/icvts\/ivaf269","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T12:45:36Z","timestamp":1766493936000},"source":"Crossref","is-referenced-by-count":1,"title":["Comparison of Meta-Analytical Estimates Between Surgical Repair and Transcatheter Edge-to-Edge Repair for Atrial Functional Mitral Regurgitation"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3457-8575","authenticated-orcid":false,"given":"Sherif","family":"Khairallah","sequence":"first","affiliation":[{"name":"Cardiothoracic Surgery Department, Weill Cornell Medicine (WCM), New York-Presbyterian Hospital , New York, NY 10065,","place":["United States"]},{"name":"Surgical Oncology Department, National Cancer Institute, Cairo University , Cairo, 11796,","place":["Egypt"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Rahouma","sequence":"additional","affiliation":[{"name":"Cardiothoracic Surgery Department, Weill Cornell Medicine (WCM), New York-Presbyterian Hospital , New York, NY 10065,","place":["United States"]},{"name":"Surgical Oncology Department, National Cancer Institute, Cairo University , Cairo, 11796,","place":["Egypt"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4997-7707","authenticated-orcid":false,"given":"Michelle","family":"Demetres","sequence":"additional","affiliation":[{"name":"Weill Cornell Medicine (WCM), Samuel J. 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Starr Biomedical Information Center , New York, NY, 10065,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonardo","family":"Girardi","sequence":"additional","affiliation":[{"name":"Cardiothoracic Surgery Department, Weill Cornell Medicine (WCM), New York-Presbyterian Hospital , New York, NY 10065,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Gaudino","sequence":"additional","affiliation":[{"name":"Cardiothoracic Surgery Department, Weill Cornell Medicine (WCM), New York-Presbyterian Hospital , New York, NY 10065,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aina","family":"Hirofuji","sequence":"additional","affiliation":[{"name":"Cardiothoracic Surgery Department, Weill Cornell Medicine (WCM), New York-Presbyterian Hospital , New York, NY 10065,","place":["United 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