Mitral transcatheter edge to edge repair versus isolated mitral surgery for severe mitral regurgitation: A French nationwide study

International audienceBackground and aims: Mitral valve surgery and more recently mitral transcatheter edge-to-edge repair (TEER) are the two treatments of severe mitral regurgitation in eligible patients. Clinical comparison of both therapies remains limited by the number of patients analysed. The objective of this study was to analyse the outcomes of mitral TEER versus isolated mitral valve surgery at a nationwide level in France.Methods: Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients treated for mitral regurgitation with isolated TEER or isolated mitral valve surgery between 2012 and 2022. Propensity score matching was used for the analysis of outcomes.Results: A total of 57,030 patients were found in the database. After matching on baseline characteristics, 2,160 patients were analysed in each arm. At 3-year follow-up, TEER was associated with significantly lower incidence of cardiovascular death (HR 0.685, 95% CI 0.563-0.832; p < 0.001), pacemaker implantation and stroke. Non-cardiovascular death (HR 1.562, 95% CI 1.238-1.971; p = 0.0001), recurrent pulmonary edema and cardiac arrest were more frequent after TEER. No significant differences between the two groups were observed regarding all-cause death (HR 0.967, 95% CI 0.835-1.118; p = 0.65), endocarditis, major bleeding and atrial fibrillation and myocardial infarction.Conclusions: Our results suggest that TEER for severe mitral regurgitation was associated with lower cardiovascular mortality than mitral surgery at long-term follow-up. Pacemaker implantation and stroke were less frequently observed after TEER