Prophylactic Left Atrial Appendage Occlusion During Mitral Valve Repair in Patients Without Atral Fibrillation: A Meta‐Analysis of Time to Event Data

Abstract

Background: Mitral valve repair (MVr) is effective for mitral regurgitation, but the benefit of prophylactic left atrial appendage occlusion (LAAO) in patients without prior atrial fibrillation (AF) remains unclear. This meta-analysis aimed to assess the long-term safety and efficacy of LAAO in this understudied population. Methods: We performed a meta-analysis from four major databases until December 2025. Kaplan-Meier curves data were reconstructed and analyzed using Cox regression models and hazard ratios (HR) for thromboembolic events (mainly stroke). A random-effects meta-analysis was performed with R software to calculate risk ratios (RR), hazard ratios (HR), and mean differences (MD), all with 95% confidence intervals (CIs). Results: Three studies with 5048 patients were included. LAAO was associated with a significant reduction in thromboembolic risk at 5 years (HR 0.60, 95% CI 0.46 to 0.77). LAAO reduced in-hospital stroke (RR 0.43, 95% CI 0.25 to 0.72) but increased postoperative AF (RR 1.17, 95% CI 1.09 to 1.26). No significant differences were observed in 30-day mortality (RR 0.56, 95% CI 0.07 to 4.33) or hospital stay (MD -0.16 days, 95% CI - 0.48 to 0.16). Conclusions: Prophylactic LAAO during MVr in patients without AF may reduce thromboembolic events risk but appears to increase postoperative AF. Further randomized studies are warranted.