A Comparison of Percutaneous Mitral Valve Repair and Surgical Mitral Valve Intervention: A Systematic Review and Meta-Analysis

BACKGROUND & AIM: Transcatheter edge-to-edge repair (TEER) has expanded options for high-risk patients with severe mitral regurgitation (MR), however its longer-term performance relative to surgical mitral valve repair (SMVR) remains uncertain. This systematic review and meta-analysis compares the clinical outcomes of TEER versus SMVR in adults with MR. METHODS: We performed a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided systematic review and random-effects meta-analysis of randomised and comparative observational studies including adults with primary or secondary MR treated with TEER (MitraClip therapy) or SMVR. Primary outcomes were mortality, reintervention and recurrent ≥3+ MR; secondary outcomes included stroke, acute kidney injury (AKI) and permanent pacemaker implantation. Subgroup analyses explored modification by MR aetiology, study design and surgical strategy. RESULTS: Twenty-one studies (70,641 patients; 24,820 TEER, 45,821 SMVR) met the inclusion criteria. TEER recipients were older, more comorbid and had higher baseline risk. In-hospital and 30-day mortality were similar between strategies. At 1 year, mortality was significantly higher after TEER (risk ratio [RR] 1.58, 95% confidence interval [CI] 1.10-2.28). Within 1 year, reintervention was almost three-fold more frequent after TEER (RR 2.98, 95% CI 2.14-4.14), and recurrent ≥3+ MR was substantially higher both at approximately 1 year (RR 4.80, 95% CI 1.97-11.72) and 3 years (RR 6.51, 95% CI 2.60-16.29). TEER was associated with a lower 1-year stroke risk, while pooled AKI and pacemaker outcomes did not differ significantly. CONCLUSIONS: TEER is a short-term alternative for high-risk patients but demonstrates higher long-term recurrence and reintervention. SMVR remains superior for durability and survival. Further studies are needed to evaluate TEER in high-risk surgical cohorts.