Comparative Outcomes of Transcatheter Edge-to-Edge Repair and Surgical Mitral Valve Repair or Replacement for Degenerative Mitral Regurgitation: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis.

Traditionally, surgical mitral valve repair or replacement (SMVR) has been the mainstay of treatment for mitral regurgitation (MR), providing a long-lasting way to restore valve competence. On the other hand, transcatheter edge-to-edge repair (TEER) has emerged as an option, especially for high surgical risk patients, demonstrating favorable results from short-term to intermediate-term follow-up. This study aims to evaluate and compare the clinical outcomes of TEER versus SMVR in patients with degenerative mitral regurgitation (DMR). This systematic review was conducted in accordance with the PRISMA guidelines. A comprehensive literature search was conducted until February 2, 2025. Relevant randomized controlled trials (RCTs) and cohort studies were included in the analysis. The data were extracted, and analysis was conducted using Review Manager (RevMan) version 5.3. Eight studies involving a total of 13,308 patients were included in the analysis. TEER showed a statistically significantly higher risk of 1-year mortality (RR 1.82, 95% CI: 1.04-3.19) and mitral reintervention at ≥ 1-year follow-up (RR 4.52, 95% CI: 3.46-5.91). However showing lower risk of new-onset AF (0.21, 95% CI: 0.07-0.67), blood transfusion (RR 0.21, 95% CI, 0.13-0.34), septicemia (RR 0.13, 95% CI: 0.02-0.70), AKI (RR 0.45, 95% CI: 0.24-0.86), shorter hospital stay (MD -4.44 days, 95% CI: -6.60 to -2.27), and ICU stay (MD -1.00 days, 95% CI: -1.13 to -0.88), when compared to the SMVR group. Survival at ≥ 2-year follow-up was significantly favored in the surgery group (RR 0.72, 95% CI: 0.56-0.93). No significant differences were observed regarding 30-day mortality (RR 0.99, 95% CI: 0.77-1.27), MR grade 1 (RR 1.16, 95% CI: 0.60-2.21), stroke (RR 1.06, 95% CI: 0.37-3.03), HF rehospitalization (RR 2.36, 95% CI: 0.82-6.81), and wound infection (RR, 0.45, 95% CI: 0.05-4.27). TEER was associated with a significantly lower rate of postoperative MR grade 0 (RR 0.20, 95% CI: 0.08-0.49), and significantly higher rates of MR grades 2 (RR 4.82, 95% CI: 1.87-12.40), 3 (RR 8.39, 95% CI: 3.69-19.09), and 4 (RR 4.20, 95% CI: 1.45-12.18), indicating inferior MR resolution. Although TEER is associated with a lower risk of septicemia and may reduce the risk of new-onset AF, hospital stay, and ICU stay, current evidence doesn't support the use of TEER as a substitute for surgery in patients with SMVR, as TEER may be associated with higher 1-year mortality and reduced long-term survival. Further controlled trials are needed to validate these findings and identify patient subgroups that may derive the greatest benefit from TEER.