Abstract Background Being characterized by high mortality and recurrence rates, native mitral valve infective endocarditis (IE) constitutes a burden on both patients and surgeons from its poor prognosis and debatable interventions. Mitral valve repair (MVRr) and mitral valve replacement (MVRp) are two main surgical methods. Nevertheless, which of them carries an outweigh benefit over the other is still controversial. Thus, in our meta-analysis we aimed to further investigate the efficacy of each technique on both short term and long-term outcomes. Methods Our search strategy was applied on several databases including the PubMed, Scopus, Web of science, and Cochrane literature databases to compare MVP and MVR, with data extracted for baseline characteristics, mortality, survival, recurrent endocarditis, and valve reoperation. Risk and hazard ratio (RR and HR) and 95% confidence interval (CI) were pooled and analyzed using RevMan 5.0. Results A total of 22 relevant publications with a total population of 10,965 patients, with 3,557 patients having undergone MVRr and 7,408 patients having undergone MVRp, respectively, were analyzed. Patients who underwent MVP may benefit from a lower risk of early mortality (RR 0.44; 95% CI, 0.38–0.51; p<0.00001; I2=0%), a higher long-term survival rate (HR 0.56; 95% CI, 0.36–0.76; p<0.001; I2=0%), and a lower risk of recurrence (RR 0.66; 95% CI, 0.40–0.93; p=0.05; I2=0%). Although the risk of reoperation was observed lower for MVRr, it was not statistically significant (RR, 0.86; 95% CI, 0.36–1.36; p=0.76; I2=37%). Conclusion Our results suggests that MVRr showed superiority in the terms of in hospital mortality and long-term survival. Furthermore, it has lower risk of recurrence and valve reoperation. Therefore, MVRr is an appropriate as a primary treatment choice and should be considered whenever possible in most IE patients. Conclusion Our results suggests that MVRr showed superiority in the terms of in hospital mortality and long-term survival. Furthermore, it has lower risk of recurrence and valve reoperation. Therefore, MVRr is an appropriate as a primary treatment choice and should be considered whenever possible in most IE patients. Funding Acknowledgement Type of funding sources: None.