This retrospective cohort study compared 3-year outcomes of mitral transcatheter edge-to-edge repair (m-TEER) versus surgical mitral valve repair in patients <70 years with functional or degenerative MR, using four U.S. state admissions databases from 2013–2022 (n=9,542).
Freedom from major adverse valve-related events (MAVRE: death, stroke, re-intervention, or HF readmission) at 3 years was significantly higher after surgery (91% vs. 78%; aHR 1.45, 95% CI 1.14–1.84). In degenerative MR specifically, m-TEER carried nearly double the MAVRE risk (aHR 1.90). m-TEER use grew from 7% to 21% between 2016–2022, with 24% of practice variation explained by hospital-level factors.
- Retrospective observational design using administrative databases limits causal inference and may not capture full clinical detail (e.g., anatomy, symptom severity, operator expertise). - Significant baseline differences between groups (m-TEER patients were older, sicker, more often functional MR) may persist despite multivariable adjustment. - Data from only four U.S. states may limit generalizability nationally.
In patients younger than 70, surgical repair appears to offer substantially better 3-year freedom from adverse valve events than m-TEER, particularly for degenerative MR — clinicians should be cautious about extending m-TEER to younger, lower-risk surgical candidates outside of a structured protocol or trial. The high institutional variability in m-TEER use suggests that referral patterns, not just patient anatomy, are driving adoption.
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