The study compared transcatheter edge-to-edge repair (TEER) and surgical mitral valve repair in patients with non-rheumatic mitral regurgitation using TriNetX data from 2013–2022. They identified 35,753 patients, including 2,165 after TEER and 33,588 after surgical repair; after propensity score matching, they analyzed 2,029 matched pairs. The primary outcome was all-cause mortality, secondary cardiovascular events. At one year, surgery had a lower mortality rate (HR: 0.78; 95% CI: 0.64–0.96), especially between 2 months and 1 year. Surgery was associated with higher early rates of dyspnoea, atrial fibrillation, and heart failure, although the heart failure was later reversible. No differences were found in major adverse cardiovascular events (MACE), stroke, acute myocardial infarction, cardiac arrest, or emergency department visits. In patients with mitral valve prolapse, outcomes were similar, with more frequent atrial fibrillation and heart failure after surgery. The study supports individualized treatment of mitral regurgitation.