Transcatheter Edge-to-Edge Repair Versus Mitral Valve Surgery in Octogenarians: Comparative Analysis of Safety, Durability, and Survival

This single-center retrospective study compared the outcomes of mitral valve (MV) surgery vs transcatheter edge-to-edge repair (TEER) in octogenarians with moderate-to-severe or severe mitral regurgitation (MR). Between 2014 and 2024, 744 patients aged 80 years and older underwent MV intervention. After exclusions and 1:1 propensity matching, 252 patients (126 per group) were analyzed. Thirty-day mortality was low and similar between the groups (1.6 percent for surgery vs 0.8 percent for TEER). Surgery was associated with higher early morbidity (atrial fibrillation, prolonged ventilation, and longer ICU/hospital stays), but echocardiography at discharge showed less residual MR and tricuspid regurgitation, as well as lower right ventricular systolic pressure. At the median follow-up of 3.9-years, recurrent MR was significantly less frequent after surgery (6 percent vs 33 percent), and five-year survival favored surgery (68 percent vs 56 percent). While TEER offered advantages such as shorter hospitalization and fewer immediate complications, surgery provided superior valve durability, fewer reinterventions, reduced heart failure readmissions, and improved long-term survival in appropriately selected octogenarians.