https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Ulm Klinik für Innere Medizin II Ulm, Deutschland; 2Alb-Donau Klinikum Innere Medizin Ehingen (Donau), Deutschland
Introduction:
Prevalence of tricuspid regurgitation (TR) increases with age. Accordingly, transcatheter edge-to-edge tricuspid valve repair (T-TEER) is regularly performed in elderly patients. However, impact of patient age on outcome after T-TEER has not been studied well. We investigated the efficacy and safety of T-TEER in octogenarians.
Prevalence of tricuspid regurgitation (TR) increases with age. Accordingly, transcatheter edge-to-edge tricuspid valve repair (T-TEER) is regularly performed in elderly patients. However, impact of patient age on outcome after T-TEER has not been studied well. We investigated the efficacy and safety of T-TEER in octogenarians.
Methods:
350 patients from the TricUlm registry were included in this analysis. All patients underwent transcatheter tricuspid valve repair at our center. Patients were stratified by age (</≥ 80 years). Baseline clinical characteristics, course of TR and heart failure (HF) symptoms as well as hospitalisations for heart failure (HFH) and all-cause mortality up to 2 years post-TEER were registered.
350 patients from the TricUlm registry were included in this analysis. All patients underwent transcatheter tricuspid valve repair at our center. Patients were stratified by age (</≥ 80 years). Baseline clinical characteristics, course of TR and heart failure (HF) symptoms as well as hospitalisations for heart failure (HFH) and all-cause mortality up to 2 years post-TEER were registered.
Results:
203 patients were included in the octogenarian group (mean age 83.7 ± 2.7 years), 147 in the non-octogenarian group (71.2 ± 9.4 years). Elderly patients were more often female (60.6 vs. 49.7%, p = 0.04), had lower body mass index (25.7 ± 4.7 vs. 27.5 ± 6.3 kg/m², p < 0.001) and had a higher prevalence of atrial fibrillation (92.6 vs. 83.0%, p = 0.006). Prevalence of cancer was also numerically higher in these patients (21.3 vs. 13.6%, p = 0.07). Octogenarians also had more pronounced renal failure (mean glomerular filtration rate 39.7 ± 17.9 vs. 48.8 ± 23.1 ml/min). Patients < 80 years however more often had HF with reduced ejection fraction (HFrEF; 21.7 vs. 9.2%, p = 0.009). No differences were seen regarding median TRI-SCORE, baseline TR severity or HF symptoms by New York Heart Association functional class.
203 patients were included in the octogenarian group (mean age 83.7 ± 2.7 years), 147 in the non-octogenarian group (71.2 ± 9.4 years). Elderly patients were more often female (60.6 vs. 49.7%, p = 0.04), had lower body mass index (25.7 ± 4.7 vs. 27.5 ± 6.3 kg/m², p < 0.001) and had a higher prevalence of atrial fibrillation (92.6 vs. 83.0%, p = 0.006). Prevalence of cancer was also numerically higher in these patients (21.3 vs. 13.6%, p = 0.07). Octogenarians also had more pronounced renal failure (mean glomerular filtration rate 39.7 ± 17.9 vs. 48.8 ± 23.1 ml/min). Patients < 80 years however more often had HF with reduced ejection fraction (HFrEF; 21.7 vs. 9.2%, p = 0.009). No differences were seen regarding median TRI-SCORE, baseline TR severity or HF symptoms by New York Heart Association functional class.
Procedural success was achieved similarly in both groups. Follow-up was registered up to 2 years after T-TEER, median follow-up was 263 days (IQR 100.3 – 499.8 days). Long-term TR reduction to moderate or lower was achieved equally (73.5% at latest available follow-up in patients ≥ 80 years, 73.2% in patients < 80 years, p = 0.97). HF symptoms were reduced significantly regardless of patient age (p for both groups < 0.001) and there was no difference in NYHA functional class at the latest follow-up (NYHA class ≥ 3 in 39.8% of octogenarians vs. 42.2% in non-octogenarians, p = 0.75).
All-cause mortality up to 2 years after T-TEER did not differ between the two groups, however it was numerically higher in younger patients (octogenarians: 11.5%, non-octogenarians 18.4%, p = 0.38). HFH occurred in 20.9 and 24.2%, respectively (p = 0.77).
A baseline NYHA functional class of 4 was an independent predictor of mortality in both younger and older patients (Hazard Ratio (HR) in patients < 80 years 5.971, 95% confidence interval (CI) 1.881 – 18.958, p = 0.002; HR in patients ≥ 80 years 7.590, 95% CI 1.187 – 48.542, p = 0.032).
Conclusion:
Similar reduction of TR severity and HF symptoms can be achieved by T-TEER in patients younger and older than 80 years. While octogenarians more often present with severe comorbidities, their survival after T-TEER is comparable to younger patients. HF symptoms at rest (NYHA functional class IV) predict worse survival regardless of age. Higher age should therefore not be a decisive factor when considering patients for T-TEER.
Similar reduction of TR severity and HF symptoms can be achieved by T-TEER in patients younger and older than 80 years. While octogenarians more often present with severe comorbidities, their survival after T-TEER is comparable to younger patients. HF symptoms at rest (NYHA functional class IV) predict worse survival regardless of age. Higher age should therefore not be a decisive factor when considering patients for T-TEER.