Key result
Transcatheter mitral valve replacement (TMVR) was associated with a significantly higher 30-day mortality compared to transcatheter edge-to-edge repair (TEER) (OR 1.68), although 1-year mortality did not differ significantly.
Why the study?
Mitral regurgitation is increasingly treated with less invasive transcatheter approaches, but comparative data between TMVR and TEER are limited.
Does transcatheter mitral valve replacement (TMVR) improve outcomes compared to transcatheter edge-to-edge repair (TEER) in patients with mitral regurgitation?
Systematic Review (n=43,111)
Does transcatheter mitral valve replacement (TMVR) improve outcomes compared to transcatheter edge-to-edge repair (TEER) in patients with mitral regurgitation?
Odds Ratio: 1.68 (95% CI 1.31–2.16)
p-value: p=<0.0001
While TMVR provides greater and more consistent reduction in mitral regurgitation, it carries significantly higher procedural risks, including increased 30-day mortality and bleeding complications, compared to the safer TEER approach.
BACKGROUND: Mitral regurgitation affects 2% of the population globally, with a widely increasing prevalence. Although mitral regurgitation is most commonly corrected by open surgery, there has been a recent shift toward less invasive transcatheter approaches, including both transcatheter edge-to-edge repair (TEER) and transcatheter mitral valve replacement (TMVR). METHODS: A comprehensive literature search was conducted using four databases: PubMed, Cochrane Library, Virtual Health Library (VHL), and Web of Science (WOS), following the PRISMA guidelines. Relevant observational studies were assessed for reporting using STROBE guidelines, whereas case reports were assessed using CARE guidelines. Independent reviewers evaluated studies based on eligibility criteria and analyzed relevant studies. RESULTS: Postoperative complications observed in patients undergoing either technique (TMVR or TEER) included acute kidney injury, stroke, access site complications, and postoperative bleeding. These complications were generally more frequent in patients after TMVR. Myocardial infarction, prosthesis malposition, and valve migration were reported exclusively after TMVR, whereas ischemic cardiomyopathy was associated with TEER. Regarding hemodynamic outcomes, TMVR patients were associated with greater MR reduction to ≤ 1, frequently observed complete MR resolution, near-laminar blood flow, and marked improvement in left ventricular function (assessed using LVEDVI and LVESVI). TMVR was associated with significantly higher 30-day mortality, whereas pooled 1-year mortality did not differ significantly between TMVR and TEER. CONCLUSION: Although TEER remains the safer option in appropriately selected patients, TMVR offers greater efficacy in MR resolution at the cost of higher procedural risk. However, findings should be interpreted with caution, given that patient selection between TMVR and TEER patients may influence observed outcomes.
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Safadi et al. (2026) conducted a systematic review in Mitral regurgitation (n=43,111). Transcatheter mitral valve replacement (TMVR) vs. Transcatheter edge-to-edge repair (TEER) was evaluated on 30-day mortality (OR 1.68, 95% CI 1.31-2.16, p=<0.0001). Transcatheter mitral valve replacement (TMVR) was associated with a significantly higher 30-day mortality compared to transcatheter edge-to-edge repair (TEER) (OR 1.68), although 1-year mortality did not differ significantly.
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