Temporal Trends in Mitral Valve Repair Procedures and Outcomes Among Older U.S. Adults

Mitral valve (MV) transcatheter edge-to-edge repair (M-TEER) has reshaped the management of mitral regurgitation in high surgical risk patients. As M-TEER adoption expands, understanding concurrent changes in procedural utilization, patient characteristics, and clinical outcomes is important.

The objective of the study was to evaluate temporal trends in procedural utilization, comorbidity burden, and mortality among Medicare beneficiaries undergoing MV repair.

Medicare beneficiaries undergoing MV repair between 2017 and 2021 were analyzed. Procedure volumes, Elixhauser Comorbidity Index, and mortality at 30-days, 30-days postdischarge, 1-year, and 2-years were assessed. Temporal mortality trends were analyzed using adjusted Cox models with calendar year as a continuous variable.

Among 81,215 beneficiaries, 39,097 underwent M-TEER and 42,118 surgical MV repair. M-TEER utilization increased from 15.0 to 27.6 per 100,000 beneficiaries (+84.0%), whereas surgical MV repair decreased from 29.1 to 20.7 per 100,000 (-28.9%), resulting in a 9.5% overall increase in MV repair use. The Elixhauser Comorbidity Index increased overall (+7.8%), remained stable among M-TEER patients (-0.2%), and decreased among surgical MV repair patients (-5.1%). Overall, adjusted mortality decreased at 30-days (adjusted HR [aHR]: 0.92; 95% CI: 0.89-0.94; P < 0.001), postdischarge 30-days (aHR: 0.93; 95% CI: 0.89-0.97; P < 0.001), 1-year (aHR: 0.98; 95% CI: 0.97-1.00; P = 0.013), and 2-years (aHR: 0.98; 95% CI: 0.97-0.99; P < 0.001).

Between 2017 and 2021, M-TEER utilization increased substantially whereas surgical MV repair declined, resulting in increased overall MV repair utilization. Over the same period, adjusted short-term and midterm mortality improved despite a higher overall comorbidity index.