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

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.