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Cox proportional hazards models were used to examine the association between EFT frailty and all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 206 patients were analyzed; median age was 76 [72\u201382] years, and 55% were male. According to the EFT, 49 patients (24%) were non-frail, 127 patients (62%) were pre-frail, and 30 patients (15%) were frail. Estimated survival at 2\u00a0years was 88\u2009\u00b1\u20095% for non-frail patients, 74\u2009\u00b1\u20095% for pre-frail patients, and 62\u2009\u00b1\u200910% for frail patients, with a hazard ratio of 1.54 (95% CI 1.16\u20132.04;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003) per standard deviation of EFT score. This association remained virtually unchanged when adjusted for other risk factors and Fried physical frailty, but disappeared when adjusted for the multidimensional prognostic index (MPI), which is based on a comprehensive geriatric assessment. A stepwise approach using EFT in all patients and MPI only in pre-frail EFT patients resulted in two risk categories with a 4.4-fold (95% CI 2.3\u20139.4) difference in 2-year mortality between categories.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The EFT has prognostic value for patients undergoing TMTVR. Due to its simplicity, the EFT could serve as a first-line frailty assessment tool to guide therapeutic decision-making, potentially in a stepwise approach with MPI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                    <jats:p>Modified Essential Frailty Toolset (EFT) (adapted from J. Afilalo et al., JACC [2017]) [14] and Kaplan\u2013Meier survival plots for all-cause mortality by frailty according to the EFT score<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-026-02864-z","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T07:56:49Z","timestamp":1771315009000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Modified essential frailty toolset for risk stratification in transcatheter mitral and tricuspid valve repair"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1875-1163","authenticated-orcid":false,"given":"Matthieu","family":"Sch\u00e4fer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8980-4598","authenticated-orcid":false,"given":"Clemens","family":"Metze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline F.","family":"Hasse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9390-0160","authenticated-orcid":false,"given":"Jan","family":"Althoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7948-202X","authenticated-orcid":false,"given":"Thorsten","family":"Gietzen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4710-8508","authenticated-orcid":false,"given":"Karl","family":"Finke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3871-164X","authenticated-orcid":false,"given":"Jennifer","family":"von Stein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4548-3897","authenticated-orcid":false,"given":"Philipp","family":"von Stein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1637-3413","authenticated-orcid":false,"given":"Jan","family":"Wrobel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1336-6031","authenticated-orcid":false,"given":"Richard J.","family":"Nies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merve","family":"Kural","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7655-8500","authenticated-orcid":false,"given":"Christos","family":"Iliadis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6361-5825","authenticated-orcid":false,"given":"Marcel","family":"Halbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8259-1737","authenticated-orcid":false,"given":"Stephan","family":"Baldus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8881-904X","authenticated-orcid":false,"given":"M. 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Clin Res Cardiol 110(5):658\u2013666. https:\/\/doi.org\/10.1007\/s00392-020-01789-5","journal-title":"Clin Res Cardiol"}],"container-title":["Clinical Research in Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00392-026-02864-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00392-026-02864-z","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00392-026-02864-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T07:56:51Z","timestamp":1771315011000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00392-026-02864-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,17]]},"references-count":29,"alternative-id":["2864"],"URL":"https:\/\/doi.org\/10.1007\/s00392-026-02864-z","relation":{},"ISSN":["1861-0684","1861-0692"],"issn-type":[{"value":"1861-0684","type":"print"},{"value":"1861-0692","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,17]]},"assertion":[{"value":"11 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"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\u2013116).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"SB has received honoraria for lectures and research grants from JenaValve (Irvine, California), Medtronic (Dublin, Ireland), Abbott Cardiovascular (Chicago, Illinois), and Edwards Lifesciences (Unterschlei\u00dfheim, Germany). CI has received travel expenses and consultant fees from Abbott Cardiovascular and Edwards Lifesciences. CFH has received travel expenses from Boehringer\/Ingelheim (Ingelheim am Rhein, Germany) and Lilly Deutschland (Bad Homburg, Germany). MIK has received travel expenses and consulting fees from Edwards Lifesciences, Abbott Cardiovascular, JenaValve, and Siemens Healthineers (Forchheim, Germany). RP has received speaker fees from Edwards Lifesciences and Abbott Cardiovascular and consultancy fees from Edwards Lifesciences. JvS has received speaker honoraria and travel fees from Edwards Lifesciences. The other authors declare that they have no relationship with industry.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}