Mitral Transcatheter Edge-to-Edge Repair in Younger Adults

Younger patients aged ≤65 years who have significant comorbidities deemed unsuitable for surgery, transcatheter edge-to-edge repair (TEER) may serve as an alternative, although the long-term outcomes remain uncertain. This study aimed to compare clinical outcomes after TEER between younger patients (aged ≤65 years) and elderly patients (aged >65 years).

A retrospective analysis was performed on 1364 consecutive patients with mitral regurgitation. The primary end point was 3-year all-cause mortality. Optimal device success was defined as achieving mild or less residual mitral regurgitation and less than 5 mm Hg transmitral mean gradient.

In the current cohort, 247 patients (18.1%) were younger than 65 years (median age: 58 years; interquartile ranges: 52-62), with 62.8% being men. Those younger patients had lower left ventricular ejection functions and were more likely to have secondary mitral regurgitation, congestive heart failure. Despite a higher-risk clinical profile, composite of all-cause mortality, heart failure hospitalization, or reintervention after TEER were comparable between younger and older patients. Younger patients demonstrated significantly lower 3-year all-cause mortality compared with older patients (18.5% versus 30.3%, P=0.007). Younger patients with device success had the lowest mortality compared with elderly patients with unsuccessful procedures (13.9% versus 34.3%, P=0.001). Among patients with unsuccessful procedures, TEER did not improve outcomes in younger patients compared with older patients. Propensity-matched analysis confirmed that younger patients continued to demonstrate lower 3-year all-cause mortality (18.5% versus 34%, P=0.034).

Younger mitral regurgitation patients undergoing TEER had more advanced congestive heart failure but lower 3-year mortality than elderly patients. However, those without optimal device success showed no survival benefit over their older counterparts, underscoring the need for close follow-up and consideration of timely reintervention.