Transcatheter Mitral Valve Replacement Devices Multiply

The Transcatheter mitral valve replacement has been established as gold standard for patients with intermediate or high risk severe aortic stenosis. The supporting evidence was initially gathered with one or two safe and effective devices that worked really well, so that later on prosthetic valves multiplied, for competing companies wanted their share of the market.

However, transcatheter mitral valve replacement is still in its infancy; it can be offered to patients with symptomatic mitral valve regurgitation as a less invasive option when extreme risk rules out conventional surgery. Devices have also multiplied ─as in the case of aortic valves─ but it seems there are too many simply because there is no perfect one.

Read also: “Five-Year Outcomes for Appendage Closure”.

Device implantation was successful in 48 patients, with a 14-minute deployment time. Mortality at 30 days was 14%, with no disabling strokes or repeat interventions.

Read also: “TCT 2017 | INTREPID: Mitral Replacement with a Self-Expanding Device”.

Mean follow up was 173 days (range 54 to 342 days) when the last echocardiogram in each patient confirmed mild or no residual regurgitation, consistent with significant improvement of symptoms. 79% of patients reported functional class I or II at follow up (p<0.0001 compared against baseline).

Conclusion

Transcatheter mitral valve replacement with this new device resulted feasible in this high or extreme risk population. These results lay the groundwork for a larger study with patients al lower risk.

Editorial Comment

The smaller profile of this valve allowed implantation in conditions previously counter indicated (such as prior transcatheter aortic valve replacement), particularly in women and in small ventricles where the risk of outflow tract obstruction can be high.

Apical bleeding was associated to 3 deaths, which raises an obvious concern and calls for perfecting this technique and which, when deemed unsafe, will eventually make us decide against this procedure.  At present, a new trans septal delivery system is being developed to avoid the need of minimal thoracotomy and its complications.

Original title: Early Experience with New Transcatheter Mitral Valve Replacement.

Referemce: Vinayak Bapat et al. J Am Coll Cardiol 2018;71:12–21.

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