Key result
M-TEER offers elderly mitral regurgitation patients safe repair with ~2% to 3% 30-day mortality.
Why the study?
Prevalence of mitral regurgitation rises with age, and elderly patients frequently face increased surgical risk due to frailty and comorbidities, precluding conventional surgery.
Do transcatheter mitral valve interventions (M-TEER and TMVR) improve outcomes in elderly patients with mitral regurgitation?
Do transcatheter mitral valve interventions (M-TEER and TMVR) improve outcomes in elderly patients with mitral regurgitation?
M-TEER is a safe and effective treatment for elderly patients with mitral regurgitation and high surgical risk, while TMVR is an emerging alternative for those with unsuitable anatomy.
May inform M-TEER decisions in high-risk elderly MR; leaves open randomized confirmation of benefit versus conservative care.
The prevalence of mitral regurgitation (MR), particularly degenerative MR (DMR), rises with advancing age. Elderly patients frequently carry increased surgical risk due to frailty and comorbidities, leading to a prohibitive risk of conventional surgery. For such patients, mitral transcatheter edge-to-edge repair (M-TEER) provides a minimally invasive alternative to surgical repair. Data from large registries, including TRAMI (Transcatheter Mitral Valve Interventions) and EXPAND (The MitraClip™ EXPAND Study of the Next Generation of MitraClip™ Devices), demonstrate high procedural success, low 30-day mortality (2-3%) and stroke rates (<1%), and durable improvements in functional status and quality of life (QoL) in elderly cohorts. Although definitions of "elderly" vary between studies (≥75, ≥80, or ≥85 years) and benefits are consistently observed, elderly was defined ≥75 years within this review. For selected patients unsuitable for M-TEER, transcatheter mitral valve replacement (TMVR) can achieve effective MR elimination, with reported 1-year mortality ranging from 7% to 17% in early transfemoral, transseptal experiences and up to 29% after transapical TMVR. This review summarizes current evidence on safety, functional outcomes, QoL, survival, emerging replacement strategies, and conservative management in elderly patients with MR.
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Felbel et al. (2026) conducted a review in Mitral regurgitation in elderly patients. Transcatheter mitral valve interventions (M-TEER and TMVR) vs. Conservative management or conventional surgery was evaluated. M-TEER provides a minimally invasive alternative with high procedural success and low 30-day mortality (2-3%) for elderly patients with mitral regurgitation, while TMVR serves as an emerging option for anatomically unsuitable patients.
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