Introduction

Mitral valve regurgitation (MR) is a common finding in the community setting and incidence increases with age. [1] Moderate to severe MR is associated with excess mortality and frequent heart failure hospitalizations if left untreated. [2] Mitral valve edge-to-edge repair (M-TEER) offers a clinical solution for patients who are deemed unfit for surgery [3], and current European guidelines on the management of valvular heart disease may consider M-TEER in selected patients with primary or secondary MR, after careful clinical evaluation and heart team discussion. [4] Recent randomized controlled trials like RESHAPE-HF2 [5] and MATTERHORN [6] further strengthen the role of M-TEER in daily clinical practice. Recent landmark randomized controlled trials, including RESHAPE-HF2 and MATTERHORN, were industry-sponsored trials. This contextualizes the independent, real-world nature of the present study, which draws on routine healthcare data from a large statutory health insurance fund without commercial funding or influence.

Already described predictors are the extend of MR reduction after M-TEER, moderate to severe tricuspid regurgitation at baseline and the presence of renal insufficiency and other comorbidities. [7], [8], [9], [10], [11], [12] Until now, no-large scale, real-world data exist, which allows us to estimate long-term mortality in patients undergoing M-TEER. Especially in this patient clientele, age, frailty and comorbidities play an evident role for patient selection and clinical decision making. Hence, we analysed data from a large German sickness fund with over eight million members, covering approximately 10 % of the German population to further elucidate on the influence of age, frailty and multimorbidity on long-term mortality after M-TEER.