Mitral Transcatheter Edge-to-Edge Repair in Younger Adults.

Younger patients (≤65 years) represented 18.1% of the total TEER cohort and had a distinct clinical profile compared to older patients.

• 247 of 1364 consecutive patients were aged ≤65 years (18.1%)
• Median age of younger patients was 58 years (IQR: 52–62)
• 62.8% of younger patients were men
• Younger patients had lower left ventricular ejection fractions and were more likely to have secondary mitral regurgitation and congestive heart failure

Younger patients demonstrated significantly lower 3-year all-cause mortality compared with older patients.

• 3-year all-cause mortality was 18.5% in younger patients versus 30.3% in older patients (P=0.007)
• This was the primary end point of the study
• Propensity-matched analysis confirmed the finding: 18.5% versus 34% (P=0.034)
• The survival advantage persisted despite younger patients having a higher-risk clinical profile

The composite outcome of all-cause mortality, heart failure hospitalization, or reintervention after TEER was comparable between younger and older patients.

• Despite lower all-cause mortality in younger patients, the composite end point did not differ significantly between the two age groups
• This suggests younger patients may have had higher rates of heart failure hospitalization or reintervention that offset the mortality benefit in the composite outcome

Optimal device success, defined as achieving mild or less residual mitral regurgitation and less than 5 mmHg transmitral mean gradient, was associated with significantly better outcomes in younger patients.

• Younger patients with device success had the lowest mortality compared with elderly patients with unsuccessful procedures (13.9% versus 34.3%, P=0.001)
• Optimal device success was defined as achieving mild or less residual MR and <5 mmHg transmitral mean gradient
• Among patients with unsuccessful procedures, TEER did not improve outcomes in younger patients compared with older patients

Among patients without optimal device success, younger patients showed no survival benefit over their older counterparts.

• The absence of survival benefit in younger patients with unsuccessful TEER procedures underscores the critical importance of achieving procedural success
• The authors highlight the need for close follow-up and consideration of timely reintervention in younger patients who do not achieve device success
• This finding suggests that suboptimal TEER results may be particularly consequential for younger patients given their longer expected lifespan

Younger patients undergoing TEER had a higher-risk baseline clinical profile than older patients.

• Younger patients were more likely to have secondary mitral regurgitation
• Younger patients were more likely to have congestive heart failure
• Younger patients had lower left ventricular ejection fractions
• These patients were deemed unsuitable for surgery due to significant comorbidities, making TEER an alternative treatment