Background Transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) is increasingly performed in elderly patients. Limited data is available analyzing outcomes in this special population.

Aims To analyze baseline and procedural characteristics as well as outcomes in higher age patients undergoing M-TEER.

Methods This retrospective study included 1118 consecutive patients undergoing M-TEER between January 2010 and May 2021. Patients were dichotomized according to the cohort´s median age [79 years (74 – 83)]. Degenerative (DMR) and functional mitral regurgitation (FMR) were analyzed separately.

Results The elderly cohort presented more often with DMR (56 vs. 27%; p<0.001), higher left ventricular ejection fraction (47±15 vs. 41±17%; p<0.001) and NYHA grade (3.2±0.6 vs. 3.1±0.7; p=0.002).

Pre- and postprocedural MR grades (3.8±0.4 in the older vs. 3.8±0.4 in the younger cohort, p=0.91 and 1.4±0.6 vs. 1.5±0.7; p=0.62) as well as procedure times (5235±1870 vs. 5235±4006; p=0.98) were comparable between both cohorts.

Kaplan-Meier analyses showed comparable reintervention and rehospitalization rates between both cohorts (p=0.49 and p=0.33). Death occurred in 29.3% of the elderly and 26.4% of the younger patients (p=0.008).

In higher age patients, regression analysis identified NYHA IV [Hazard ratio (HR): 1.7 95%-Confidence interval (CI): 1.1-2.7; p=0.022], preprocedural NT-pro BNP >3247 pg/ml [HR 2.1 (95%-CI: 1.3-3.6); p=0.005 eGFR [HR 0.98 (95%-CI 0.98-0.97); p=0.007], as well as periprocedural infection [HR 2.6 (95%-CI: 1.4-5.1] as significant independent predictors of death.

When separating higher age patients by MR etiology, in FMR patients only NT-pro BNP >3247 pg/ml [HR 5.7 (95%-CI: 1.9-16.5); p=0.001] predicted mortality. However, residual MR grade ≤1 [HR 0.4 (95%-CI: 0.17-0.98); p=0.045], periprocedural infection [HR 3.9 (95%-CI 0.94-16.5] and cardiogenic shock [HR 45.9 95%-CI: 4.9-429.8); p<0.001] were significant independent predictors of death in the DMR cohort.

Conclusion TEER displays a safe and effective treatment option in elderly patients with MR. In higher age patients advanced heart failure indicated by higher NT-pro BNP, worse renal function and NYHA IV predicts mortality. Thus, M-TEER should not be withheld from elderly patients.