Comparing mitral transcatheter edge-to-edge repair and surgical intervention in mitral regurgitation: A meta-analysis

Surgery remains the standard treatment for severe mitral valve regurgitation (MR), but growing evidence highlights the potential role of mitral valve percutaneous edge-to-edge repair (M-TEER). This meta-analysis aims to compare 12-month all-cause mortality between M-TEER and surgical intervention (SMVI). A systematic search (October 2024) of PubMed, Cochrane, Scopus, and Web of Science identified randomized control trials (RCTs) and propensity-matched observational studies comparing 12-month all-cause mortality in MR patients treated with M-TEER or SMVI. An inverse variance random-effects meta-analysis assessed outcomes using risk ratios (RR) and 95% confidence intervals (CI). Two RCTs (MATTERHORN and EVEREST II) and three observational studies totaling 1,782 patients, were included in the final analysis. A non-significant trend of higher mortality at 30 days was observed in the SMVI group (RR: 0.72; CI: 0.26-2.00), along with higher complication rates mainly due to bleeding. At 12 months follow-up, SMVI was associated with a significantly lower risk of all-cause mortality (RR: 1.41; CI: 1.11-1.81), while the M-TEER group had more patients with MR grade 3 or higher (RR: 4.05; CI: 1.54-10.67), with a non-significant trend of higher rate of MR reintervention (RR 2.51; CI 0.83-7.66) at 12 months. Based on current evidence, M-TEER should continue to be reserved for patients with prohibitive high surgical risk. While propensity-matched cohorts were pooled for the study estimates, the limited available data from randomized trials, combined with heterogeneity in patient populations, particularly regarding MR etiology, underscores the need for further studies.