Dec. 18, 2025
With a growing octogenarian population in the U.S., Mayo Clinic cardiac surgeons are expanding treatment options for patients with mitral regurgitation (MR) — one of the most common valvular heart diseases.
The Cardiovascular Surgery researchers investigated the short- and long-term outcomes of surgical and transcatheter interventions for treating MR in patients 80 and older. The study was published in the Journal of Thoracic and Cardiovascular Surgery (JTCVS).
The current guidelines recommend transcatheter edge-to-edge repair (TEER) for patients with symptomatic moderate to severe (grade 3-plus) or severe (grade 4-plus) MR who are at high risk of surgical valve repair or replacement.
"Octogenarians represent one of the fastest-growing groups referred for mitral intervention, yet they remain understudied in direct comparisons between TEER and mitral valve surgery. In clinical practice, many patients age 80 and older are steered toward TEER primarily because of age, even when they may be good surgical candidates. We conducted this study to generate contemporary, real-world evidence to clarify outcomes in this population and to determine whether chronological age alone should guide therapy selection," says Arman Arghami, M.D., M.P.H., a cardiovascular surgeon at Mayo Clinic in Rochester, Minnesota. Dr. Arghami was senior author of the research.
Demonstrating long-term durability
This study can help with deciding between a less invasive transcatheter procedure and a surgical choice in certain patients. "While both approaches were safe in octogenarians, our work provides detailed long-term echocardiographic follow-up, something largely missing from prior studies," says Dr. Arghami. "We demonstrate that in the propensity-matched cohort, surgery results in more sustained MR reduction, better tricuspid valve and pulmonary pressure profiles, and significantly lower progression of right-sided pressures over time. These findings show that surgery offers not only superior long-term durability, but also more favorable hemodynamic remodeling. This level of follow-up can help counsel patients better and avoid reflexive TEER referrals based solely on chronological age."
Early mortality was low for the two treatments. "This confirms that both are safe for selected octogenarians. TEER patients recovered faster and had fewer early complications, but they experienced more recurrent MR and required more reinterventions over time," says Dr. Arghami. "In contrast, surgery offered more durable valve repair and better survival. The echocardiographic follow-up clearly showed more sustained reduction in MR severity and less deterioration of right-sided pressures after surgery."
The researchers found that:
- Baseline characteristics were comparable between the TEER and mitral valve (MV) surgery groups. In the study cohort of 252 patients, the median patient age was 83.5 years and 78.2% had degenerative MR.
- The 30-day mortality was similar in both groups (MV surgery, 1.6%; TEER, 0.8%; P = 0.561).
- Postoperatively, the MV surgery group had higher rates of atrial fibrillation, prolonged mechanical ventilation, and longer intensive care unit and hospital stays (P < 0.001 for all).
- Predischarge echocardiography showed less residual MR (2.4% vs. 8%; P < 0.001), less tricuspid regurgitation (10.5% vs. 50%; P < 0.001), and lower right ventricular systolic pressure (37.5 mm Hg vs. 44 mm Hg; P < 0.001) in the MV surgery group.
- For a median 3.9-year follow-up, the incidence of recurrent MR remained lower in the MV surgery group (6.4% vs. 33.3%; P < 0.001).
- The five-year survival was superior in the MV surgery group (68% vs. 56%; P = 0.019).
Looking beyond age
In clinical practice today, many physicians advise TEER rather than MV surgery for treating octogenarian patients. "For patients who are frail and high-risk for surgery, TEER is an excellent option. But our findings show that age alone should not exclude patients from considering surgery," says Dr. Arghami. "Many octogenarians do well surgically, especially when treated at experienced centers. Look beyond chronological age and consider physiologic age, frailty, anatomy and functional status."
Physiologic age reflects the reserve and resilience of a patient's organs and systems relative to what is typical for their age group rather than the number of years a patient has lived. Evaluating physiologic age can help personalize surgical decisions for octogenarian patients and improve outcomes.
Next steps
Mayo Clinic Cardiovascular Surgery specialists emphasize a tailored, patient-centered approach. This study shows that with careful selection of octogenarian patients, surgery can offer:
- Fewer readmissions.
- Improved survival.
- Superior short- and long-term valve durability.
Multicenter confirmation of the findings will be essential. "We'll need better tools to measure physiologic age, including the use of our model of AI-ECG age and more refined frailty assessments. Longer-term functional and quality-of-life follow-up will also be important," says Dr. Arghami. "Ultimately, combining anatomy, frailty, and AI-ECG physiologic age may give teams a more precise way to match each patient with the therapy that will serve them best over time."
For more information
Danesh S, et al. Transcatheter edge-to-edge repair versus mitral valve surgery in octogenarians: Comparative analysis of safety, durability and survival. Journal of Thoracic and Cardiovascular Surgery. In press.
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