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. 2025 Jul;114(7):827-835.
doi: 10.1007/s00392-024-02397-3. Epub 2024 Feb 15.

Frailty, periinterventional complications and outcome in patients undergoing percutaneous mitral and tricuspid valve repair

Matthieu Schäfer  1 , Hannah Nöth  2 , Clemens Metze  2 , Christos Iliadis  2 , Maria Isabel Körber  2 , Marcel Halbach  2 , Stephan Baldus  2 , Roman Pfister  2
Affiliations

Frailty, periinterventional complications and outcome in patients undergoing percutaneous mitral and tricuspid valve repair

Matthieu Schäfer et al. Clin Res Cardiol. 2025 Jul.

Abstract

Background: Frailty is common in elderly and multimorbid patients and associated with increased vulnerability to stressors.

Methods: In a single centre study frailty according to Fried criteria was assessed in consecutive patients before transcatheter mitral and tricuspid valve repair. Postprocedural infections, blood transfusion and bleeding and renal failure were retrospectively assessed from records. Median follow-up time for survival was 560 days (IQR: 363 to 730 days).

Results: 90% of 626 patients underwent mitral valve repair, 5% tricuspid valve repair, and 5% simultaneous mitral and tricuspid valve repair. 47% were classified as frail. Frailty was associated with a significantly increased frequency of bleeding (16 vs 10%; p = 0.016), blood transfusions (9 vs 3%; p = < 0.001) and infections (18 vs 10%; p = 0.006), but not with acute kidney injury (20 vs 20%; p = 1.00). Bleeding and infections were associated with longer hospital stays, with a more pronounced effect in frail patients (interaction test p < 0.05, additional 3.2 and 4.1 days in frail patients, respectively). Adjustment for the occurrence of complications did not attenuate the increased risk of mortality associated with frailty (HR 2.24 [95% CI 1.62-3.10]; p < 0.001).

Conclusions: Bleeding complications and infections were more frequent in frail patients undergoing transcatheter mitral and tricuspid valve repair and partly explained the longer hospital stay. Albeit some of the complications were associated with higher long-term mortality, this did not explain the strong association between frailty and mortality. Further research is warranted to explore interventions targeting periprocedural complications to improve outcomes in this vulnerable population.

Keywords: Acute Kidney Injury; Bleeding; Frailty; Infection; MitraClip.

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Conflict of interest statement

Declarations. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. All enrolled patients gave written informed consent. The study was approved by the local ethics committee of the University of Cologne (14–116). Competing interests: CI has received travel support by Abbott Cardiovascular (Abbott Park, Chicago, US) and Edwards Lifesciences (Unterschleißheim, Germany) and consultant honoraria by Abbott and Edwards Lifesciences. MIC received travel support and proctor and lecture fees from Edwards lifesciences, Abbott and JenaValve (Irvine, US). RP received fees for presentations and consultancy by Edwards Lifesciences. SB received research grants and speaker honoraria by Edwards Lifesciences and Abbott and speaker honoraria from Medtronic (Dublin, Ireland). The other authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Frequency of periinterventional complications by frailty status. Frequency of periinterventional complications by frailty status in %, p-values for difference of incidence between frail and non-frail patients
Fig. 2
Fig. 2
Effect estimate* of periinterventional complications on length of hospital stay by frailty status. *unstandardized regression coefficient from linear regression analysis and standard deviation. p-values for interaction by frailty status
Fig. 3
Fig. 3
Kaplan-Meier survival plot for all-cause mortality by frailty status. Plot of survival functions for frail patients versus non-frail patients. CI = confidence interval, HR = hazard ratio
See this image and copyright information in PMC

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