Clinical, Functional, and Quality‐of‐Life Outcomes After Contemporary Transcatheter Edge‐to‐Edge Repair for Primary Mitral Regurgitation in the Very Elderly

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Primary mitral regurgitation (n=854). Intervention: Very advanced age (≥85 years) undergoing mitral TEER vs. Younger age (<85 years) undergoing mitral TEER. Primary outcome: 1-year all-cause mortality (HR 1.74, 95% CI 1.02-2.98, p=0.04).

Q: What does this research mean for the field?

Mitral transcatheter edge-to-edge repair in the very elderly is associated with low complication rates and substantial improvements in ventricular remodeling, functional status, and quality of life, despite higher 1-year mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Matthew J. Price; Gagan D. Singh; Jim Rogers; Michael J. Rinaldi; Paul Mahoney; Paolo Denti; Wolfgang Rottbauer; Federico M Asch; J. L. Zamorano; Janani Aiyer; Kelli Peterman; Francesco Maisano; Ralph Stephan von Bardeleben; Evelio Rodríguez; Saibal Kar

doi:10.1161/jaha.125.044794

March 18, 2026Journal of the American Heart AssociationOpen Access

Clinical, Functional, and Quality‐of‐Life Outcomes After Contemporary Transcatheter Edge‐to‐Edge Repair for Primary Mitral Regurgitation in the Very Elderly

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Key result

Very elderly patients (≥85 years) undergoing mitral transcatheter edge-to-edge repair had higher 1-year mortality compared to younger patients (12.2% vs. 9.9%, HR 1.74), but achieved comparable procedural safety and significant quality-of-life improvements.

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Why the study?

Does mitral transcatheter edge-to-edge repair offer similar safety, functional, and quality-of-life benefits in very elderly patients (≥85 years) compared to younger patients with primary mitral regurgitation?

Key Points

To assess clinical outcomes, functional status, ventricular remodeling, and quality of life following transcatheter edge-to-edge repair for primary mitral regurgitation in very elderly patients.
Evaluated 854 patients with primary mitral regurgitation from the EXPANDed study, stratified into 4 age quartiles: Q1 (<77 years, n=207), Q2 (77–81 years, n=208), Q3 (82–84 years, n=212), and Q4 (≥85 years, n=227).
Compared 30-day major adverse events, echocardiographic indices, NYHA functional class, KCCQ-OS score, 6-minute walk distance, and 1-year clinical endpoints between Q4 and younger cohorts (Q1–Q3, n=627).
At 30 days, major adverse event rates did not differ significantly between Q4 and Q1–Q3 (5.7% vs 4.3%, P=0.46), and MR ≤2+ was achieved in 96% vs 97% of patients at 1 year (P=0.91).
Functional and quality-of-life outcomes improved significantly at 1 year in both Q4 and Q1–Q3, including NYHA class I/II status (81.3% vs 85.6%, both P<0.0001) and KCCQ-OS improvements (∆+17.7 ± 24.4 vs ∆+19.1 ± 23.4, P=0.76).
Kaplan–Meier estimated 1-year mortality was 12.2% in Q4 compared with 9.9% in Q1–Q3 (adjusted HR, 1.74 [95% CI, 1.02–2.98], P=0.04), and the composite of mortality or heart failure hospitalization was 21.1% versus 17.5% (adjusted HR, 1.61 [95% CI, 1.08–2.41], P=0.02).

Study Design

Type

Observational (n=854)

Multicenter

Yes

Structured PICO

Does mitral transcatheter edge-to-edge repair offer similar safety, functional, and quality-of-life benefits in very elderly patients (≥85 years) compared to younger patients with primary mitral regurgitation?

P

Population

854 patients with symptomatic moderate-to-severe or severe primary mitral regurgitation undergoing mitral transcatheter edge-to-edge repair, followed for 1 year.

E

Exposure

Mitral transcatheter edge-to-edge repair (TEER) using 3rd and 4th-generation devices.

C

Comparator

Younger patients (aged <85 years) with primary mitral regurgitation undergoing the same transcatheter edge-to-edge repair procedure.

O

Outcome

Major adverse events at 30 days (composite of death, myocardial infarction, stroke, surgical mitral valve replacement, single leaflet device attachment, and device embolization), and key clinical measures at 1 year including MR severity, NYHA class, KCCQ-OS score, heart failure hospitalization, and mortality.composite

Main Result

Hazard Ratio: 1.74 (95% CI 1.02–2.98)

Absolute Event Rate: 12.2% vs 9.9%

p-value: p=0.04

Limitations

Selection bias may have influenced outcomes as physicians may have preferentially selected very elderly patients more likely to benefit.
Follow-up was limited to 1 year, which may not fully capture the long-term trajectory of outcomes.
Lack of detailed information on frailty, which strongly influences post-procedural recovery, health status gains, and mortality.
Selection bias, as physicians may have preferentially selected very elderly patients more likely to benefit
Follow-up was limited to 1 year
Detailed information on frailty was not collected
Small sample size limited the ability to detect significant differences in MR reduction

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Implication

TEER may confer QoL gains with low complications in selected very elderly patients; leaves open age-specific candidacy pending randomized data.

Abstract

Although 1-year mortality was higher among the very elderly, mitral transcatheter edge-to-edge repair using next-generation devices was associated with low complication rates and substantial improvements in ventricular remodeling, functional status, and quality of life across age groups. These findings support the use of mitral transcatheter edge-to-edge repair in appropriately selected elderly patients and suggest that age alone should not be a barrier to treatment.

Discussion

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Cite This Study

Price et al. (2026) conducted an observational in Primary mitral regurgitation (n=854). Very advanced age (≥85 years) undergoing mitral TEER vs. Younger age (<85 years) undergoing mitral TEER was evaluated on 1-year all-cause mortality (HR 1.74, 95% CI 1.02-2.98, p=0.04). Very elderly patients (≥85 years) undergoing mitral transcatheter edge-to-edge repair had higher 1-year mortality compared to younger patients (12.2% vs. 9.9%, HR 1.74), but achieved comparable procedural safety and significant quality-of-life improvements.

synapsesocial.com/papers/69be38446e48c4981c678907 https://doi.org/10.1161/jaha.125.044794

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Clinical, Functional, and Quality‐of‐Life Outcomes After Contemporary Transcatheter Edge‐to‐Edge Repair for Primary Mitral Regurgitation in the Very Elderly

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Clinical, Functional, and Quality‐of‐Life Outcomes After Contemporary Transcatheter Edge‐to‐Edge Repair for Primary Mitral Regurgitation in the Very Elderly

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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