What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Severe mitral regurgitation (n=23825). Intervention: Mitral transcatheter edge-to-edge repair (m-TEER) vs. Surgery (surgical valve repair or replacement). Primary outcome: All-cause mortality (RR 1.02, 95% CI 0.77-1.37, p=0.87).

October 14, 2025European Heart Journal Open1 citationsOpen Access

Mitral Transcatheter edge-to-edge repair rivals surgery for survival despite less complete correction: a systematic review and metanalysis of randomized and propensity score matching studies

GPGianluca Di PietroPoliclinico Umberto I RIRiccardo ImprotaPoliclinico Umberto I ALAntonio LattanzioPoliclinico Umberto I

Key Result

Mitral transcatheter edge-to-edge repair resulted in comparable all-cause mortality to surgery (RR 1.02) at 18 months, but had higher rates of heart failure rehospitalization and reintervention.

Study Design

Type

Meta-Analysis (n=23,825)

Multicenter

Yes

Structured PICO

Does mitral transcatheter edge-to-edge repair reduce mortality and heart failure rehospitalization compared to surgery in patients with severe mitral regurgitation?

Population

23,825 patients with severe mitral regurgitation (MR) from 9 studies (2 RCTs and 7 propensity score matching studies). Median age 74 for m-TEER and 72 for surgery.

Intervention

Mitral transcatheter edge-to-edge repair (m-TEER)

Comparator

Surgical valve repair (with 1.6% undergoing mitral valve replacement)

Outcome

All-cause mortality at a median follow-up of 18 monthshard clinical

In patients with severe mitral regurgitation, m-TEER provides comparable mid-term survival to surgery, but surgery is associated with lower rates of heart failure rehospitalization, mitral reintervention, and residual MR.

Main Result

Effect estimate: RR 1.02 (95% CI 0.77-1.37)

p-value: p=0.87

Limitations

Inclusion of propensity score-matched studies introduces variability and cannot account for unmeasured confounders.
A small proportion of surgical patients underwent valve replacement, which may influence outcomes such as residual MR.
Heterogeneity of MR etiology without stratification may obscure differential treatment effects.
Median follow-up of 18 months may not be sufficient to capture the full durability benefit of surgery.
Baseline risk differences between the cohorts may bias secondary outcomes despite propensity score adjustment.
Variability in operator experience and procedural techniques between trials.
Lack of standardized definitions or reporting of residual MR severity and heart failure hospitalization criteria across studies.

Abstract

Abstract Aims To compare outcomes of patients with severe mitral regurgitation (MR) after m-TEER and surgery. Methods and results PubMed, Scopus, and Google Scholar databases were searched for randomized controlled trials and propensity score matching studies comparing mid-term outcomes of m-TEER vs. surgical valve repair. All-cause of death, rehospitalization for heart failure, mitral reintervention, NYHA class at clinical follow-up and grade ≥ 3 at echocardiographic follow-up were the outcomes of interest. Additional sensitivity analyses were performed to account for heterogeneity. Nine studies (2 RCT and 7 propensity score matching studies) with a total of 23 825 patients (m-TEER group = 11 970; surgery group = 11 855) were included. Surgery and m-TEER were associated with comparable rates of all-cause mortality at a median follow-up of 18 months (RR 1.02, 95%CI 0.77–1.37, P-value 0.87). Surgical repair was associated with a reduced risk of rehospitalization for heart failure (RR 1.70, 95%CI 1.47–1.98, P value 0.01) and mitral reintervention (RR 3.27, 95%CI 2.49–4.30, P value 0.01), due to a reduced at least moderate residual MR (RR 6.35, 95%CI 1.43–28.22, P value 0.02). Conclusion In patients with severe MR, m-TEER resulted in comparable outcomes for all-cause deaths compared to surgery, although the latter was associated with reductions in heart failure rehospitalization, reintervention and MR residual rates at a median 18-month follow-up.

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