Transcatheter edge to edge compared with surgery in older patients with degenerative mitral valve regurgitation.

Objectives: Transcatheter edge-to-edge repair (TEER) is an alternative for patients with severe degenerative mitral regurgitation (MR). The objective of this study was to compare the outcomes of surgery and TEER in older patients with degenerative MR patients using real life data.

Methods: Consecutives older patients (≥ 65 years-old), with severe symptomatic, degenerative MR requiring surgery or TEER between 2013 and 2023 were included. Exclusion criteria were secondary MR, and active endocarditis. Primary outcome was a composite of all-cause death, hospitalization for heart failure or mitral valve intervention within one year.

Results: A total of 295 patients were included (203 underwent surgery and 92 underwent TEER). At 1 year, 26 (9%) patients had died, required reintervention or rehospitalization for heart failure: 8 patients in the surgery group (4%) and 18(20%) in the TEER group(p < 0.01). Factors independently associated with the combined outcome were residual MR > 2 (aHR 4.31 (95% CI: 1.51-12.25)), history of cardiac surgery (aHR 6.24 (95%CI: 2.16-18.05)), BMI (aHR 0.88 (95% CI: 0.77-0.98)), TR > 2 at baseline (aHR: 2.47 (95% CI: 1.03-5.91)). After adjustement on confounding factors, intervention type was not associated with the primary composite outcome (aHR: 3.41 (95% CI: 0.63-18.27)), p = 0.15).

Conclusion: Patients with severe primary MR treated with TEER experienced a higher rate of adverse events within one year compared to surgically managed patients. However, these differences were mainly associated to clinical characteristics and were no longer significant after adjustment on residual MR > 2.