Transcatheter edge-to-edge repair versus mitral valve surgery in octogenarians: Comparative analysis of safety, durability, and survival

Objective: To investigate the short- and long-term outcomes of surgical and transcatheter interventions for treating mitral regurgitation (MR) in patients age ≥80 years. Methods: Between 2014 and 2024, 744 patients age ≥80 years underwent mitral valve (MV) surgery (n = 390) or transcatheter edge-to-edge repair (TEER; n = 354) at our institution. Of these, 466 patients without additional procedures or MV stenosis met the inclusion criteria. Application of 1:1 propensity score matching yielded a final matched cohort of 252 patients. Results: After matching, baseline characteristics were comparable between the TEER and MV surgery groups. In the entire study cohort, the median patient age was 83.5 years (interquartile range, 81.7-85.9 years), and 78.2% had degenerative MR. Thirty-day mortality was similar in the 2 groups (MV surgery, 1.6%; TEER, 0.8%; P = .561). Postoperatively, the MV surgery group had higher rates of atrial fibrillation, prolonged mechanical ventilation, and longer intensive care unit and hospital stays (P < .001 for all). Predischarge echocardiography showed less residual MR (2.4% vs 8%; P < .001), less tricuspid regurgitation (10.5% vs 50%, P < .001), and lower right ventricular systolic pressure (37.5 mm Hg vs 44 mm Hg; P < .001) in the MV surgery group. Over a median 3.9-year follow-up, the incidence of recurrent MR remained lower (6.4% vs 33.3%; P < .001), and 5-year survival was superior (68% vs 56%; P = .019) in the MV surgery group. Conclusions: Both surgical correction of MR and TEER can be performed relatively safely in octogenarians. Although TEER is associated with shorter hospital stays and fewer procedure-related complications, MV surgery results in a lower rate of recurrent MR and better late survival.