Felbel Dominik, Paukovitsch Michael, Gröger Matthias, Markovic Sinisa, Schneider Leonhard, Rottbauer Wolfgang, Keßler Mirjam
Department of Cardiology, Ulm University Heart Center, Ulm, Germany.
ESC Heart Fail. 2025 Jun;12(3):1663-1675. doi: 10.1002/ehf2.15177. Epub 2024 Dec 4.
Prevalence of mitral regurgitation (MR) and comorbidity burden rise with age. Mitral valve transcatheter edge-to-edge repair (M-TEER) is increasingly performed in elderly patients, but only limited data are available for this specific subgroup. In this study, outcomes of octogenarians and nonagenarians undergoing M-TEER were analysed using a large real-world dataset.
This retrospective study included consecutive patients undergoing M-TEER at the Ulm University Heart Center between January 2010 and December 2021. The cohort was divided into an elderly group and a younger group based on the cohorts' median age. Group differences regarding 1 and 3 year mortality and heart failure hospitalization rates were assessed using Kaplan-Meier survival analysis and Cox proportional hazard models.
A total of 1118 patients [median age 79 (inter-quartile range 74-83) years; 42% female] were included and divided into 513 elderly (≥80 years) and 605 younger (<80 years) patients. Primary MR was more frequent in the elderly group (56% vs. 27%, P < 0.001). Pre-procedural and post-procedural MR grades were comparable between groups (pre-procedural MR grade 4: 69% in the elderly group vs. 71% in the younger group, P = 0.67; post-procedural MR grade 1: 60% in the elderly group vs. 58% in the younger group, P = 0.77) as well as in-hospital mortality rates (0.2% vs. 0.3%, P = 0.66). Three-year heart failure hospitalization rates did not differ significantly between both groups (30.7% in the older age cohort vs. 36.0% in the younger cohort, P = 0.191). While 1 year all-cause mortality rates were comparable (18% vs. 16.4%, P = 0.577), 3 year all-cause mortality was significantly higher in the elderly [43.1% vs. 33.0%; hazard ratio (HR) 1.29 (95% confidence interval 1.02-1.65), P = 0.035]. Pre-procedural N-terminal pro-brain natriuretic peptide (NT-proBNP) ≥3402 pg/mL [HR 2.29 (95% CI 1.34-3.90), P = 0.002], pre-interventional MR grade [HR 1.79 (95% CI 1.01-3.17), P = 0.045] and European System for Cardiac Operative Risk Evaluation (EuroSCORE) II [HR 1.06 (95% CI 1.03-1.08), P < 0.001] were identified as independent predictors of 3 year mortality in the elderly.
M-TEER displays a safe and effective treatment option for elderly patients with symptomatic MR, offering symptom relief and comparable 1 year outcomes to younger patients. Elderly patients with elevated EuroSCORE II and advanced heart failure might benefit from additional care to further reduce 3 year mortality.
二尖瓣反流（MR）的患病率和合并症负担随年龄增长而增加。二尖瓣经导管缘对缘修复术（M-TEER）在老年患者中的应用越来越多，但针对这一特定亚组的可用数据有限。在本研究中，我们使用一个大型真实世界数据集分析了接受M-TEER的八旬和九旬老人的手术结果。
这项回顾性研究纳入了2010年1月至2021年12月在乌尔姆大学心脏中心连续接受M-TEER的患者。根据队列的年龄中位数将队列分为老年组和年轻组。使用Kaplan-Meier生存分析和Cox比例风险模型评估1年和3年死亡率及心力衰竭住院率的组间差异。
共纳入1118例患者[年龄中位数79（四分位间距74 - 83）岁；42%为女性]，并分为513例老年（≥80岁）患者和605例年轻（<80岁）患者。原发性MR在老年组中更为常见（56%对27%，P < 0.001）。术前和术后MR分级在两组之间具有可比性（术前MR 4级：老年组为69%，年轻组为71%，P = 0.67；术后MR 1级：老年组为60%，年轻组为58%，P = 0.77），住院死亡率也相当（0.2%对0.3%，P = 0.66）。两组间3年心力衰竭住院率无显著差异（老年队列中为30.7%，年轻队列中为36.0%，P = 0.191）。虽然1年全因死亡率相当（18%对16.4%，P = 0.577），但老年患者的3年全因死亡率显著更高[43.1%对33.0%；风险比（HR）1.29（95%置信区间1.02 - 1.65），P = 0.035]。术前N末端脑钠肽前体（NT-proBNP）≥3402 pg/mL [HR 2.29（95% CI 1.34 - 3.90），P = 0.002]、介入前MR分级[HR 1.79（95% CI 1.01 - 3.17），P = 0.045]和欧洲心脏手术风险评估系统（EuroSCORE）II [HR 1.06（95% CI 1.03 - 1.08），P < 0.001]被确定为老年患者3年死亡率的独立预测因素。
M-TEER为有症状的老年MR患者提供了一种安全有效的治疗选择，可缓解症状且1年结果与年轻患者相当。EuroSCORE II升高和晚期心力衰竭的老年患者可能受益于额外的护理，以进一步降低3年死亡率。
