Temporal Trends in Mitral Valve Repair Procedures and Outcomes Among Older U.S. Adults.

BACKGROUND: Mitral valve (MV) transcatheter edge-to-edge repair (M-TEER) has reshaped the management of mitral regurgitation in high surgical risk patients. As M-TEER adoption expands, understanding concurrent changes in procedural utilization, patient characteristics, and clinical outcomes is important. OBJECTIVES: The objective of the study was to evaluate temporal trends in procedural utilization, comorbidity burden, and mortality among Medicare beneficiaries undergoing MV repair. METHODS: Medicare beneficiaries undergoing MV repair between 2017 and 2021 were analyzed. Procedure volumes, Elixhauser Comorbidity Index, and mortality at 30-days, 30-days postdischarge, 1-year, and 2-years were assessed. Temporal mortality trends were analyzed using adjusted Cox models with calendar year as a continuous variable. RESULTS: Among 81,215 beneficiaries, 39,097 underwent M-TEER and 42,118 surgical MV repair. M-TEER utilization increased from 15.0 to 27.6 per 100,000 beneficiaries (+84.0%), whereas surgical MV repair decreased from 29.1 to 20.7 per 100,000 (-28.9%), resulting in a 9.5% overall increase in MV repair use. The Elixhauser Comorbidity Index increased overall (+7.8%), remained stable among M-TEER patients (-0.2%), and decreased among surgical MV repair patients (-5.1%). Overall, adjusted mortality decreased at 30-days (adjusted HR [aHR]: 0.92; 95% CI: 0.89-0.94; P < 0.001), postdischarge 30-days (aHR: 0.93; 95% CI: 0.89-0.97; P < 0.001), 1-year (aHR: 0.98; 95% CI: 0.97-1.00; P = 0.013), and 2-years (aHR: 0.98; 95% CI: 0.97-0.99; P < 0.001). CONCLUSIONS: Between 2017 and 2021, M-TEER utilization increased substantially whereas surgical MV repair declined, resulting in increased overall MV repair utilization. Over the same period, adjusted short-term and midterm mortality improved despite a higher overall comorbidity index.