Transcatheter Chordal Repair for Degenerative Mitral Regurgitation: Systematic Review and Meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Procedural success rate 96.2%

• Primary Outcome: Mitral regurgitation ≤ mild achieved in 93.9% at discharge, declining to 82.5% at 30 days

• Nnt Or Sensitivity: Early recurrence rate 17.5% (moderate MR at 30 days vs 5.0% at discharge)

• Confidence Interval: Not reported in abstract

Clinical Application

Requires specialized cardiac catheterization facilities with echocardiographic guidance capabilities Technology likely available in major tertiary cardiac centres; TGA approval status unclear; may be considered for high-risk surgical patients per CSANZ guidelines Adults with primary degenerative mitral regurgitation suitable for transcatheter intervention

Abstract

Transcatheter chordal repair enables off-pump, echocardiography-guided treatment of degenerative mitral regurgitation, but real-world outcomes remain variably reported. We performed a systematic review and meta-analysis of studies evaluating outcomes after transcatheter chordal repair in adults with primary degenerative mitral regurgitation. Pooled event rates were calculated using random-effects models. Seventeen studies (n = 3,787) were included. Mitral regurgitation ≤ mild was achieved in 93.9% of patients at discharge and 82.5% at 30 days, while moderate mitral regurgitation occurred in 5.0% and 17.5%, respectively. Procedural success was 96.2%, although small-study effects were suggested. Early adverse events were infrequent, with 30-day mortality of 1.2%, stroke of 0.7%, and myocardial infarction of 1.2%. Reintervention occurred in 4.5%. In conclusion, transcatheter chordal repair demonstrates high technical success and favorable early safety; however, early mitral regurgitation recurrence and heterogeneity highlight the need for anatomy-guided patient selection and cautious interpretation given single-arm study limitations.

References

1. 1.Adrejiya, P., Mehta, K., Patel, D., Shah, A., Bergmark, B., & Sharkawi, M. (2026). Transcatheter chordal repair for degenerative mitral regurgitation: Systematic review and meta-analysis. The American Journal of Cardiology. https://doi.org/10.1016/j.amjcard.2026.03.032