Transcatheter mitral valve replacement or repair for mitral regurgitation: a narrative review.

Objectives: The burden of mitral regurgitation (MR) is increasing globally. Transcatheter mitral valve repair (TMVr) is the preferred option for high-risk patients, while transcatheter mitral valve replacement (TMVR) is emerging as an alternative. The objective of this narrative review is to synthesize the available comparative evidence on these two approaches for MR. Specifically, we focus on procedural outcomes, clinical effectiveness, and patient selection criteria. Methods: This review investigates through PubMed and the Cochrane Library for studies comparing TMVR and TMVr in patients with MR until February 28, 2025. Results: We identified three observational studies, including a total of 4322 patients with MR. TMVR was associated with a higher risk of short-term mortality and peri-procedural complications but greater MR reduction and symptomatic improvement at follow-up compared to TMVr. Furthermore, there was no difference in long-term mortality between TMVR and TMVr. Conclusions: All in all, TMVr is currently preferred due to the lower procedural risks, while TMVR may provide more durable MR reduction and symptomatic improvement. Patient selection is critical, and future trials are needed to refine patient selection, and establish its role in clinical practice. Given that only three studies were eligible, this narrative review serves to describe preliminary evidence and highlight the need for more robust comparative data.