Age-Related Outcomes After Transcatheter Mitral Valve Repair in Patients With Heart Failure: Analysis From COAPT

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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair

Published on: October 16, 2021

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Chris Song1, Mahesh V Madhavan2, JoAnn Lindenfeld3

  • 1The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

JACC. Cardiovascular Interventions
|January 30, 2022
PubMed

Insights

Transcatheter edge-to-edge repair (TEER) with the MitraClip device benefits both younger and elderly patients with heart failure and secondary mitral regurgitation. While effective across age groups, elderly patients may experience a smaller reduction in heart failure hospitalizations.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Heart Failure Management

Background:

  • The COAPT trial demonstrated TEER with MitraClip reduced heart failure hospitalizations and mortality in patients with heart failure and secondary mitral regurgitation.
  • Limited data exist on MitraClip effectiveness in elderly populations.

Purpose of the Study:

  • To evaluate the impact of age on patient outcomes following TEER using the MitraClip device.
  • To compare the effectiveness of TEER versus guideline-directed medical therapy (GDMT) in different age groups.

Main Methods:

  • Analysis of 614 patients from the COAPT trial, grouped by median age (74 years).
  • Comparison of MitraClip treatment versus GDMT alone.
  • Primary endpoint: 2-year rate of death or heart failure hospitalization, assessed by multivariable Cox regression.

Main Results:

  • TEER with MitraClip reduced death or HFH in both younger (<74 years) and elderly (≥74 years) patients compared to GDMT alone.
  • Mortality reduction was consistent across age groups.
  • Elderly patients showed a trend towards a lesser reduction in HFH compared to younger patients (Pint = 0.03).
  • Quality of life improved similarly in both age groups with MitraClip treatment.

Conclusions:

  • MitraClip treatment for secondary mitral regurgitation improves survival and quality of life in both young and elderly patients with heart failure.
  • While elderly patients benefit from TEER, the reduction in heart failure hospitalizations may be less pronounced compared to younger individuals.
Abstract

Keywords:
MitraClipfunctional mitral regurgitationgeriatric cardiologytranscatheter mitral valve repair

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