Outcomes of Octogenarians Undergoing Edge-to-Edge Transcatheter Valve Repair for Tricuspid Regurgitation: Inverse Propensity Score-Weighted Analysis

Abstract

There is a scarcity of data for perioperative outcomes of octogenarians undergoing tricuspid transcatheter edge-to-edge repair (TEER), despite both the potential procedural effectiveness in treating tricuspid regurgitation and a low incidence of severe complications observed in the nonelderly population. We assessed the characteristics and outcomes of TEER in octogenarians compared to those in patients under 80 years old treated at a referral tertiary teaching hospital. We retrospectively enrolled all adult patients undergoing tricuspid TEER. The population was stratified based on age: ≥80 and <80 years. Inverse probability of treatment weighting (IPTW) propensity score was used to mitigate the risk of selection bias. Between January 2017 and September 2023, 101 patients underwent tricuspid TEER. Thirty-six (36%) were octogenarians. Crude treatment estimates indicated that preoperative Tricuspid Annular Plane Systolic Excursion (TAPSE) was significantly higher in octogenarians compared to younger patients (19 mm [IQR: 17 to 21] vs. 17 mm [IQR: 14-18]; p = 0.005). At discharge, octogenarians showed a TAPSE 2.71 mm higher than that observed in the <80 age group (95% CI: 0.79 to 4.62; p = 0.006) according to crude treatment estimates. After adjusting with IPTW-weighting, the TAPSE difference remained significant, with octogenarians having a 2.44 mm higher TAPSE (95% CI: 0.54 to 4.35; p = 0.012). IPTW-adjusted analyses indicated comparable clinical outcomes between the two groups. Adverse events and survival in octogenarians were similar to those observed in patients aged <80 years. Our findings indicate that age alone should not be the sole criterion to deny TEER.

Keywords: TEER; edge-to-edge transcatheter tricuspid valve repair; elderly patients; frailty; octogenarians; tricuspid regurgitation.