Abstract 4366685: Impact of Frailty on outcomes after transcatheter-edge-to-edge repair (TEER) in patients with mitral regurgitation (MR)

Abstract

Introduction: Transcatheter-edge-to-edge repair (TEER) has emerged as a minimally invasive option for patients with significant mitral regurgitation and high surgical risk. While frailty predicts poor outcomes in structural interventions, its impact on TEER remains unclear. We investigated the association between frailty and clinical outcomes after TEER. Methods: We performed a propensity score-matched (PSM) retrospective cohort analysis using the TriNetX Global Collaborative Network (146 healthcare organizations). Adult patients (≥18 years) with a diagnosis of pre-procedural Frailty identified by ICD R54-Age related physical debility and nonrheumatic mitral valve prolapse I34.0 or insufficiency I34.1 were identified. Two cohorts were created based on the TEER procedure identified by ICD 10 PCS:02UG3JZ. Extensive propensity matching was conducted including demographics, comorbidities, concurrent medications, BMI, eGFR, Hemoglobin, LVEF, BNP, NT-proBNP, severity of MR. After matching, N=699 in each cohort. Primary outcomes measured at one year of TEER included all-cause mortality, HF hospitalization, all-cause hospitalization, ICU admissions, major adverse cardiovascular events (MACE), major adverse kidney effects (MAKE), and stroke. Results: At one year follow up, patients with frailty who underwent TEER had outcomes comparable to those without frailty including all-cause mortality (HR 1.157, 95 % CI 0.905-1.479, P =0.158), MACE (HR 1.141, 95% CI 0.734-1.225, P= 0.942), All cause hospitalizations (HR 0.778, 95 % CI 0.237,2.552, P=0.358), Heart Failure hospitalizations (HR 1.184,95 % CI 0.798, 1.756, P=0.774), Stroke (HR 0.718, 95 % CI 0.404,1.274, P=0.210), MAKE (HR 1.323, 95 % CI 0.945, 1.851, P=0.308). Conclusion: These findings suggest that frail individuals may experience outcomes comparable to non-frail patients, indicating that TEER may be a safe and feasible treatment option for this vulnerable population. Further validation through prospective studies is warrante