Transcatheter Edge-to-Edge Repair in Older Adults With Mitral and Tricuspid Valve Disease

The older adult population is expanding rapidly. Parallel to this expansion, cardiologists care for a larger population of patients with clinically significant mitral regurgitation and tricuspid regurgitation who are ineligible for surgical repair due to frailty, multimorbidity, and coexisting geriatric conditions. Transcatheter edge-to-edge repair has emerged as a safe and effective alternative, with randomized trials and contemporary registries demonstrating durable reduction in regurgitation, improved functional status, and lower heart failure hospitalizations across age groups. Integration of geriatric cardiology tools to address frailty, cognition, delirium risk, nutrition, polypharmacy, and social support is critical to optimize procedural outcomes. Tools including the Comprehensive Geriatric Assessment, Mini Nutritional Assessment-Short Form, Katz Index of Independence in Activities of Daily Living, Kansas City Cardiomyopathy Questionnaire, and cognitive screening instruments enable individualized risk stratification and care planning. Periprocedural and postprocedural strategies, including structured rehabilitation, early mobilization, delirium prevention, and caregiver engagement, further enhance functional recovery. Despite favorable procedural outcomes, significant gaps remain in the care for older adults, including the inconsistent characterization of frailty and cognitive status in clinical trials, which limits evidence to guide selection, limited transcatheter edge-to-edge repair-specific tools to assess age-associated risks, and scarcity of long-term data on functional independence and quality-of-life end points. Future research should prioritize patient-centered outcomes and develop integrated, multidisciplinary care pathways that align procedural success with meaningful life expectancy and functional longevity in older adults.