Interventional treatment options for elderly patients with mitral regurgitation

The prevalence of mitral regurgitation (MR), particularly degenerative MR (DMR), rises with advancing age. Elderly patients frequently carry increased surgical risk due to frailty and comorbidities, leading to a prohibitive risk of conventional surgery. For such patients, mitral transcatheter edge-to-edge repair (M-TEER) provides a minimally invasive alternative to surgical repair. Data from large registries, including TRAMI (Transcatheter Mitral Valve Interventions) and EXPAND (The MitraClip™ EXPAND Study of the Next Generation of MitraClip™ Devices), demonstrate high procedural success, low 30-day mortality (2-3%) and stroke rates (<1%), and durable improvements in functional status and quality of life (QoL) in elderly cohorts. Although definitions of "elderly" vary between studies (≥75, ≥80, or ≥85 years) and benefits are consistently observed, elderly was defined  ≥75 years within this review. For selected patients unsuitable for M-TEER, transcatheter mitral valve replacement (TMVR) can achieve effective MR elimination, with reported 1-year mortality ranging from 7% to 17% in early transfemoral, transseptal experiences and up to 29% after transapical TMVR. This review summarizes current evidence on safety, functional outcomes, QoL, survival, emerging replacement strategies, and conservative management in elderly patients with MR.