Association Between Preoperative Gait Speed and Mortality in Patients with Transcatheter Edge-to-Edge Mitral Repair

Background: Transcatheter Edge-to-Edge Repair (TEER) is a therapeutic option established for older patients with heart failure and concomitant mitral regurgitation. Frailty is associated with prognosis after transcatheter valve interventions. However, despite clinical potential, evidence for gait speed as a simplified prognostic marker in patients undergoing TEER remains insufficient. Objectives: This study aimed to investigate the association between preoperative gait speed and mid- to long-term mortality after TEER. Methods: We conducted a single-center retrospective cohort study of 97 patients (mean age: 78.9 ± 8.7 years; 56.7% male) who survived the first 7 days after TEER and had available preoperative gait speed data. Preoperative gait speed was assessed, and clinical data were obtained from medical records. Cox regression analysis was performed to elucidate the association between preoperative gait speed and mortality. Results: In Cox proportional hazards models, higher gait speed (per 0.1 m/s increase) was associated with lower mortality after adjustment for the Society of Thoracic Surgeons risk score and handgrip strength (hazard ratio: 0.81; 95% confidence interval: 0.68–0.97; p = 0.02). In time-dependent receiver operating characteristic curve analysis, gait speed showed moderate discriminative ability for mortality, with area under the curve values of 0.749 at 1 year and 0.710 at 2 years. A gait speed of 0.8 m/s was used as an exploratory threshold for survival stratification, and patients with gait speed < 0.8 m/s had lower survival than those with gait speed ≥ 0.8 m/s (log-rank p < 0.01). Conclusions: Lower preoperative gait speed was associated with higher mid- to long-term mortality after TEER. Preoperative gait speed may provide clinically useful information for exploratory risk stratification, although the cutoff-based findings require external validation.