Clinical, Functional, and Quality-of-Life Outcomes After Contemporary Transcatheter Edge-to-Edge Repair for Primary...

Advanced age may influence the benefits derived from transcatheter edge-to-edge repair for primary mitral regurgitation (MR). We explored the impact of age on clinical, echocardiographic, functional, and patient-reported outcomes after contemporary mitral transcatheter edge-to-edge repair.

Patients with primary MR were identified from a pooled, patient-level analysis of the EXPAND and EXPAND G4 studies. Key outcomes included 30-day and 1-year major adverse events, MR severity, New York Heart Association class, Kansas City Cardiomyopathy Questionnaire - Overall Summary score, and mortality.

A total of 854 patients were included. The oldest quartile ranged in age from 86 to 99 years, while the younger quartiles ranged from 21 to 85 years. The 30-day major adverse events rate was not different in the oldest compared with the younger quartiles (5.7% versus 4.3%, P=0.46). At 1 year, MR ≤1+ was present in 81% of the oldest versus 88% of the younger patients (P=0.08). LV end-diastolic volumes improved to similar extent (-12.0±28.8 mL, P=0.003 and -14.1±31.5 mL, P<0.0001, P=0.34 across groups). Functional status and Kansas City Cardiomyopathy Questionnaire - Overall Score improved significantly across age groups, without differences according to age. Adjusted 1-year mortality was higher in the oldest compared with the younger quartiles (adjusted hazard ratio 1.74 [95% CI, 1.02-2.98], P=0.04).

Although 1-year mortality was higher among the very elderly, mitral transcatheter edge-to-edge repair using next-generation devices was associated with low complication rates and substantial improvements in ventricular remodeling, functional status, and quality of life across age groups. These findings support the use of mitral transcatheter edge-to-edge repair in appropriately selected elderly patients and suggest that age alone should not be a barrier to treatment.