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Updated: Jun 28, 2026

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Transcatheter vs Surgical Mitral Valve Repair in Patients Younger Than 70 Years in the United States
Aminah Sallam1, Derrick Y Tam2, Armin Razavi3
1Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California.
Background:
Mitral transcatheter edge-to-edge repair (m-TEER) use has increased, yet its outcomes compared to surgical mitral repair in younger patients are undefined. We evaluated practice trends and 3-year outcomes of m-TEER vs surgical repair for mitral regurgitation (MR) in patients aged <70 years.
Methods:
Patients aged <70 years with functional or degenerative MR undergoing primary, elective m-TEER or surgical repair from 2013-2022 were identified in 4 state admissions databases. The primary outcome was freedom from major adverse valve-related events (MAVRE), a composite of death, stroke, mitral reintervention, or heart failure readmission, at 3 years compared using a multivariable Cox proportional hazard model adjusting for baseline differences.
Results:
Among 9542 patients with MR, 1210 (12%) underwent m-TEER and 8332 (88%) underwent surgery. Patients undergoing surgery were younger (59 vs 63 years, P < .01), had fewer comorbidities, and had degenerative disease (92% vs 46%, P < .01). From 2016-2022, m-TEER use increased from 7% to 21% (annual percent change, 21.4%, P < .01), predominantly among patients with functional MR. Hospital-level factors accounted for 24% of practice variation (intraclass correlation coefficient, 0.24; 95% CI, 0.14-0.34; P < .01). Freedom from MAVRE at 3 years was higher after surgery (91% vs 78%; adjusted hazard ratio, 1.45; 95% CI, 1.14-1.84; P < .01). In degenerative MR, m-TEER was associated with increased risk of MAVRE (adjusted hazard ratio, 1.90; P < .01).
Conclusions:
Among patients aged <70 years with MR, m-TEER use was associated with substantial institutional variability and higher MAVRE, especially among patients with degenerative MR. These findings support the need for prospective studies to better define anatomic selection criteria and comparative effectiveness in younger patients.
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