August 24, 2025

MitraClip Versus Surgery for Secondary Mitral Regurgitation: A Systematic Review and Updated Meta‐Analysis

Key Points

Patients receiving MitraClip showed a lower rate of residual mitral regurgitation ≤ 2+ compared to surgery, demonstrating its effectiveness in reducing MR.
The analysis included 11 studies with 1605 patients, revealing a significant difference in MR outcomes with a risk ratio of 0.86 for the MitraClip group.
This systematic review utilized data from various databases and assessed differences in clinical outcomes, including mortality and heart failure hospitalizations.
Findings suggest that while MitraClip reduces MR, it does not lead to improved survival or functional status compared to surgical options.

Abstract

ABSTRACT Background The optimal management of secondary mitral regurgitation (MR) remains uncertain, with surgical and percutaneous approaches offering alternative treatment strategies. Aim To compare percutaneous repair with mitral transcatheter edge‐to‐edge repair (M‐TEER) using MitraClip and surgical intervention in patients with secondary MR. Methods We systematically searched PubMed, Embase, and Cochrane for studies comparing M‐TEER using MitraClip with surgery in secondary MR, reporting outcomes of interest. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random‐effects model in R software. Heterogeneity was assessed with I² statistics. Results A total of 11 studies (two randomized controlled trials and nine observational studies) comprising 1605 patients were included. The mean age was 69 years. Among them, 906 (57.7%) underwent MitraClip. Mean follow‐up was 24.7 months (minimum: 6 months). The rate of MR grade ≤ 2+ at follow‐up was lower in the MitraClip group compared to surgery (RR: 0.86, 95% CI: 0.78 to 0.95, p < 0.01). No significant differences were observed in all‐cause mortality (RR: 1.18, 95% CI: 0.93 to 1.49, p = 0.16), cardiovascular mortality (RR: 1.42, 95% CI: 0.54 to 3.68, p = 0.47), heart failure hospitalizations (RR: 1.55, 95% CI: 0.79 to 3.04, p = 0.20), or NYHA class I/II at follow‐up (RR: 0.92, 95% CI: 0.83 to 1.01, p = 0.08). Conclusion Although patients undergoing MitraClip exhibited a lower rate of residual MR ≤ 2+ at follow‐up compared to those treated surgically, this did not translate into higher rates of clinical outcomes, including all‐cause mortality, cardiovascular mortality, heart failure hospitalizations, or impaired functional status (NYHA classification).

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