Transcatheter edge-to-edge repair versus mitral valve surgery in octogenarians: Comparative analysis of safety, durability, and survival.

Abstract

To investigate the short- and long-term outcomes of surgical and transcatheter interventions for treating mitral regurgitation (MR) in patients age ≥80 years. Between 2014 and 2024, 744 patients age ≥80 years underwent mitral valve (MV) surgery (n = 390) or transcatheter edge-to-edge repair (TEER; n = 354) at our institution. Of these, 466 patients without additional procedures or MV stenosis met the inclusion criteria. Application of 1:1 propensity score matching yielded a final matched cohort of 252 patients. After matching, baseline characteristics were comparable between the TEER and MV surgery groups. In the entire study cohort, the median patient age was 83.5 years (interquartile range, 81.7-85.9 years), and 78.2% had degenerative MR. Thirty-day mortality was similar in the 2 groups (MV surgery, 1.6%; TEER, 0.8%; P = .561). Postoperatively, the MV surgery group had higher rates of atrial fibrillation, prolonged mechanical ventilation, and longer intensive care unit and hospital stays (P < .001 for all). Predischarge echocardiography showed less residual MR (2.4% vs 8%; P < .001), less tricuspid regurgitation (10.5% vs 50%, P < .001), and lower right ventricular systolic pressure (37.5 mm Hg vs 44 mm Hg; P < .001) in the MV surgery group. Over a median 3.9-year follow-up, the incidence of recurrent MR remained lower (6.4% vs 33.3%; P < .001), and 5-year survival was superior (68% vs 56%; P = .019) in the MV surgery group. Both surgical correction of MR and TEER can be performed relatively safely in octogenarians. Although TEER is associated with shorter hospital stays and fewer procedure-related complications, MV surgery results in a lower rate of recurrent MR and better late survival.