AIMS
To assess relative survival and excess mortality after transcatheter edge-to-edge repair for significant mitral regurgitation, with a focus on sex-related differences.

METHODS AND RESULTS
A retrospective analysis was performed including consecutive subjects undergoing transcatheter edge-to-edge repair for significant mitral regurgitation between 2015 and 2024. Observed survival was estimated using actuarial life tables, while expected survival was derived from age-, sex-, and region-matched general population data using the Ederer II method. Relative survival was calculated as the ratio between observed and expected survival, and excess mortality as one minus relative survival.
Overall observed survival at one, two, and three years was 88.9%, 87.4%, and 78.9%, respectively. Excess mortality was significantly increased during the first year of follow-up and decreased thereafter, approaching that of the general population. When stratified by sex, men showed persistently reduced relative survival compared with matched controls, driven mainly by early excess mortality. In contrast, women achieved relative survival comparable to the general population from the first year onward, with no significant excess mortality during follow-up. After multivariable adjustment, sex was not an independent predictor of mortality.

CONCLUSIONS
After transcatheter edge-to-edge repair, excess mortality is concentrated in the first year. Women achieve restoration of life expectancy comparable to the general population, whereas men exhibit persistent excess mortality despite similar procedural success. Relative survival analysis provides complementary information to conventional survival metrics and may help refine risk stratification after mitral valve intervention.