Background:
Transcatheter mitral valve replacement (TMVR) has emerged as alternative to transcatheter edge-to-edge repair (TEER) for treatment of mitral valve failure, however the incremental benefits of TMVR beyond TEER have not been well studied. 

Aims:
This study evaluated clinical and echocardiographic outcomes after TMVR with the Tendyne system in comparison to TEER.

Methods:
Among patients who were judged eligible for the Tendyne system we retrospectively analyzed patients undergoing TMVR with the Tendyne system or TEER. An inverse probability of treatment weighting (IPTW) methodology was applied to balance the baseline characteristics between the groups, and we examined all-cause mortality and echocardiographic findings after the procedure.

Results: 
Of 63 patients, 17 underwent TMVR with the Tendyne system, and 46 were treated by TEER. Implantation success rate was comparable between Tendyne and TEER (94.4% vs. 93.5%). IPTW-adjusted Kaplan–Meier curves showed that patients treated with Tendyne had higher 30-day mortality than those treated with TEER, while the mortality between 30 days and one year was comparable between Tendyne and TEER (95.4% vs. 90.8%; p=0.524). The reduction of mitral regurgitation (MR) and left-ventricular end-diastolic volume at 30-day follow-up were greater in patients treated with TMVR compared to those treated with TEER. 

Conclusions: 
Among patients eligible for the Tendyne system, those treated with Tendyne had a higher mortality than those treated with TEER, which was driven by the initial 30-day mortality rate. In contrast, TMVR with the Tendyne system showed substantially better MR reduction and LV reverse remodeling than TEER.