Mitral Transcatheter Edge‐to‐Edge Repair in Younger Adults

Background Younger patients aged ≤65 years who have significant comorbidities deemed unsuitable for surgery, transcatheter edge‐to‐edge repair (TEER) may serve as an alternative, although the long‐term outcomes remain uncertain. This study aimed to compare clinical outcomes after TEER between younger patients (aged ≤65 years) and elderly patients (aged >65 years). Methods A retrospective analysis was performed on 1364 consecutive patients with mitral regurgitation. The primary end point was 3‐year all‐cause mortality. Optimal device success was defined as achieving mild or less residual mitral regurgitation and less than 5 mm Hg transmitral mean gradient. Results In the current cohort, 247 patients (18.1%) were younger than 65 years (median age: 58 years; interquartile ranges: 52–62), with 62.8% being men. Those younger patients had lower left ventricular ejection functions and were more likely to have secondary mitral regurgitation, congestive heart failure. Despite a higher‐risk clinical profile, composite of all‐cause mortality, heart failure hospitalization, or reintervention after TEER were comparable between younger and older patients. Younger patients demonstrated significantly lower 3‐year all‐cause mortality compared with older patients (18.5% versus 30.3%, P =0.007). Younger patients with device success had the lowest mortality compared with elderly patients with unsuccessful procedures (13.9% versus 34.3%, P =0.001). Among patients with unsuccessful procedures, TEER did not improve outcomes in younger patients compared with older patients. Propensity‐matched analysis confirmed that younger patients continued to demonstrate lower 3‐year all‐cause mortality (18.5% versus 34%, P =0.034). Conclusions Younger mitral regurgitation patients undergoing TEER had more advanced congestive heart failure but lower 3‐year mortality than elderly patients. However, those without optimal device success showed no survival benefit over their older counterparts, underscoring the need for close follow‐up and consideration of timely reintervention.