A real-world comparison of transcatheter edge-to-edge repair versus surgical mitral valve intervention in patients with mitral regurgitation: a TriNetX study

Q: What are the key findings of this study?

Surgical mitral valve intervention reduced 1-year all-cause mortality (HR 0.78) compared to transcatheter edge-to-edge repair in patients with non-rheumatic mitral regurgitation.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Non-rheumatic mitral regurgitation (n=35753). Intervention: Surgical mitral valve intervention vs. Transcatheter edge-to-edge repair (TEER). Primary outcome: All-cause mortality (HR 0.78, 95% CI 0.64-0.96, p=0.017).

Q: What does this research mean for the field?

Surgical repair of mitral regurgitation improves survival after 2 months compared to transcatheter edge-to-edge repair, despite higher early rates of dyspnea and atrial fibrillation. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Kuan-Chieh Tu; Jheng-Yan Wu

doi:10.3389/fmed.2026.1729871

February 9, 2026SHILAP Revista de lepidopterologíaOpen Access

A real-world comparison of transcatheter edge-to-edge repair versus surgical mitral valve intervention in patients with mitral regurgitation: a TriNetX study

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Key result

Mitral surgery is linked to ~22% lower 1-year mortality versus TEER in non-rheumatic MR.

HR 0.78
95% CI 0.64-0.96
P=0.017
n=35,753

Figures

Why the study?

Clinical outcomes comparing transcatheter edge-to-edge repair and surgical repair in patients with non-rheumatic mitral regurgitation needed evaluation using real-world data.

Does transcatheter edge-to-edge repair compared to surgical mitral valve intervention improve clinical outcomes in older adults with non-rheumatic mitral regurgitation?

Key Points

To compare clinical outcomes, including all-cause mortality and cardiovascular events, between transcatheter edge-to-edge repair (TEER) and surgical intervention in patients with non-rheumatic mitral regurgitation using real-world data.
Retrospective cohort study analyzing the TriNetX global health research network (2013–2025) of adults with mitral regurgitation.
Identified 35,753 eligible patients (2,165 TEER and 33,588 surgery cases) and formed 2,029 propensity score-matched pairs balancing demographics, comorbidities, and medications.
At 1 year, surgery demonstrated significantly lower all-cause mortality compared with TEER (8.2 vs 10.9 events per 100 person-years; HR: 0.78; 95% CI: 0.64–0.96; p=0.017), driven predominantly by lower mortality between 2 months and 1 year (HR: 0.54; 95% CI: 0.41–0.71; p<0.001).
During the early post-procedural period (day 1 to 2 months), all-cause mortality did not differ significantly between groups (HR: 1.25; 95% CI: 0.92–1.69; p=0.149).
Early follow-up showed significantly higher risks after surgery for worsening heart failure (190.8 vs 32.4 per 100 person-years; HR: 6.55; 95% CI: 5.34–8.04; p<0.001), dyspnea (HR: 2.52; 95% CI: 1.82–3.48; p<0.001), and atrial fibrillation (HR: 2.46; 95% CI: 1.89–3.20; p<0.001), while MACEs, stroke, and acute myocardial infarction showed no significant differences.

Study Design

Type

Cohort (n=35,753)

Multicenter

Yes

Structured PICO

Does transcatheter edge-to-edge repair compared to surgical mitral valve intervention improve clinical outcomes in older adults with non-rheumatic mitral regurgitation?

P

Population

35,753 adults (aged ≥65 years) with non-rheumatic mitral valve prolapse and insufficiency (2,029 propensity-matched pairs analyzed), mean age ~75.6 years, ~43.5% female, US-based (TriNetX network). Excluded: prior mitral valve intervention, exposure to both TEER and surgery.

I

Intervention

Transcatheter edge-to-edge repair (TEER)

C

Comparator

Surgical mitral valve intervention (repair or replacement)

O

Outcome

All-cause mortality at 1 yearhard clinical

Main Result

Effect estimate: HR 0.78 (95% CI 0.64-0.96)

Absolute Event Rate: 8.2% vs 10.9%

p-value: p=0.017

In older adults with non-rheumatic mitral regurgitation, surgical intervention is associated with lower 1-year mortality compared to TEER, though TEER has fewer early complications like atrial fibrillation and worsening heart failure.

Limitations

Retrospective observational design exposes the study to potential selection bias, residual confounding, and unmeasured variables (e.g., NYHA class, LVEF, surgical risk).
Reliance on aggregated electronic health records and ICD coding may introduce misclassification or underreporting.
Causal relationship between the interventions and the observed outcomes cannot be definitively established.
Information regarding the specific type of TEER devices or exact surgical techniques was unavailable.
Inability to clearly distinguish the etiology of MR or capture TEER-to-surgery conversions.
Calendar year of intervention was not available for inclusion in propensity matching, leaving potential temporal or learning-curve biases.
Granular procedural details, intraoperative findings, and imaging parameters were not captured.
Retrospective observational design with potential selection bias and residual confounding
Reliance on aggregated electronic health records and ICD coding
Lack of specific device/manufacturer information or exact surgical techniques
Unable to clearly distinguish the etiology of MR
Calendar year of intervention not available for matching

Implication

May support surgical preference for lower mortality in non-rheumatic MR; leaves open confirmation in randomized trials.

Abstract

Objective We aimed to compare the clinical outcomes of transcatheter edge-to-edge repair (TEER) and surgical repair in patients with non-rheumatic mitral regurgitation (MR) using real-world data. Methods We conducted a retrospective cohort study using TriNetX to identify adults with mitral regurgitation who underwent surgical repair or TEER (2013–2025). Propensity score matching (PSM) balanced demographics, comorbidities, and medications. The primary outcome was all-cause mortality; the secondary outcomes included cardiovascular events. Results After exclusions, 35,753 patients with mitral regurgitation were identified, including 2,165 TEER and 33,588 surgical cases; 2,029 matched pairs were analyzed. At 1 year, surgery showed lower mortality (hazard ratio [HR]: 0.78; 95% confidence interval [CI]: 0.64–0.96), primarily between 2 months and 1 year. Surgery was associated with higher rates of early dyspnea, atrial fibrillation, and heart failure, though heart failure could be reversed later. No significant differences were found in major adverse cardiovascular events (MACEs), stroke, acute myocardial infarction (AMI), cardiac arrest, or emergency department (ED) visits. A subgroup analysis of patients with mitral valve prolapse showed consistent results, with atrial fibrillation and heart failure occurring more frequently after surgery. Conclusion In this large cohort, surgery and TEER produced different outcomes. Early mortality was similar, but surgery improved survival after 2 months. TEER had fewer early dyspnea, atrial fibrillation, and heart failure events. No differences were observed in MACE, stroke, AMI, or ED visits, supporting individualized MR treatment.

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Cite This Study

Tu et al. (2026) conducted a cohort in Non-rheumatic mitral regurgitation (n=35,753). Surgical mitral valve intervention vs. Transcatheter edge-to-edge repair (TEER) was evaluated on All-cause mortality (HR 0.78, 95% CI 0.64-0.96, p=0.017). Surgical mitral valve intervention reduced 1-year all-cause mortality (HR 0.78) compared to transcatheter edge-to-edge repair in patients with non-rheumatic mitral regurgitation.

synapsesocial.com/papers/698d6d695be6419ac0d5245b https://doi.org/10.3389/fmed.2026.1729871