Promising Outcomes of Transcatheter Mitral Valve Replacement in Complex Patients

Courtesy of Dr. Carlos Fava.

The risk of repeat surgical mitral valve repair involves 6% to15% mortality at 30 days, even close to 20% in acute cases. However, mortality can rise to over 40% when it comes to a third or fourth surgical intervention. 

One of the solutions to this serious problem is transcatheter mitral valve replacement (TMVR) with balloon expandable valves in the mitral valve, being it MVinV, MVinRing or in patients with severe annular calcification (VIMAC), which also involves significantly higher complications.

The study included 903 patients. 680 received MVinV, 123 MVinRing, and 10 VIMAC.

Mean age was 75, 60% were women, 65% had atrial fibrillation, 90% were functional class III-IV and had 10% STS. 

Those presenting VIMAC had more prior TMVR and FFR was lower in MVinRing patients.

Read also: Virtual ACC 2020 | Unlike in TAVR, the Number of Mitral Valve Surgeries Does Not Improve the Outcomes of Transcatheter Mitral Valve Repairs.

The valve most used was SAPIENS 3, most used diameter was 29 in MVinV and VIMAC, and 26 in MVinRing.

The highest success rate was in MVinV and MVinRing vs. VIMAC (87.9%, 90.9% and 82.9% p<0.001), left ventricular outflow tract obstruction was more frequent in VIMAC.

In-hospital mortality was higher in VIMAC (MVinV 6.3%, MVinRing 4.9% and VIMAC 10% p=0.004).

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At 30 days, mortality was higher in VIMAC (MVinV=8.1%, MVinRing=11.5%, ViMAC=21.8%; P=0.003), there were no differences in mitral gradient and the presence of mitral regurgitation <1+. Even though most patients improved to functional class I-II, though not as much among VIMAC patients (MVinV=84.2%, MVinRing=81.8%, and ViMAC=62.9%; P=0.007).

Conclusion

The use of a transcatheter balloon expandable valve in MVinV was associated to lower mortality at 30 days (lower than the preceding STS score) and better short-term evolution vs MVinRing or VIMAC. At 30 days, all patients improved their functional class and transcatheter valve performance remained stable. 

Courtesy of Dr. Carlos Fava.

Original Title: Thirty-Day Outcomes of Transcatheter Mitral Valve Replacement for Degenerated Mitral Bioprostheses (Valve-in-Valve), Failed Surgical Rings (Valve-in-Ring), and Native Valve With Severe Mitral Annular Calcification (Valve-in- Mitral Annular Calcification) in the United States. Data From the Society of Thoracic Surgeons/American College of Cardiology / Transcatheter Valve Therapy Registry.

Reference: Mayra Guerrero, et al. Circ Cardiovasc Interv. 2020;13:e008425. DOI:10.1161/CIRCINTERVENTIONS.119.008425.

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