At present, an important group of patients with mitral valve disease are at high surgical risk, especially those with deteriorated bio-prosthesis, severe mitral annulus calcification or those who had received mitral annuloplasty.
Percutaneous treatment with balloon expandable valves is a valid option to treat these patients, seeing as their 30 day and one-year outcomes look quite promising. However, benefits beyond one year remain unknown.
The Mitral Trial 2-year outcomes were looked at, including patients receiving mitral valve in valve (MVIV) with balloon expandable valves SAPIENS XT or SAPIENS 3 due to surgical bioprosthesis failure, mitral valve-in-ring (MViR) for failed annuloplasty and valve-in-mitral annular calcification (ViMAC) for severe mitral annular calcification.
It included 30 patients with MVIV, 30 MViR and 31 ViMAC.
Patients presenting ViMAC had mean age 75, 71% were women, 39% had diabetes, and 63% ejection fraction. Left ventricle outflow tract (LVTO) 160 mm2 and STS 8.6%.
In MVIR patients mean age was 72, 37% were women, 30% diabetic, 13% were oxygen dependent, left ventricular ejection fraction was 47%. LVTO was 440 mm2 and STS 8.7%.
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In MVIV, mean age was 76, 63% were women, 20% were diabetic, 10% oxygen dependent and LV ejection fraction was 56% LVTO was 330mm2 and STS 10.2%.
At two-year followup, all-cause mortality for ViMAC, MViR and MVIV was 39%, 43.3% and 6.7% respectively, and cardiovascular mortality was 21.4%, 17% and 3.3% respectively.
The presence of gradient and mitral regurgitation ≥2+ was 5.6% and 100% in ViMAC; 5.2 mmHg and 100% in MViR; and 5.5% and 96% in MVIV.
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They all improved functional class and quality of life significantly.
Conclusion
The use of balloon expandable valves in select patients with severe mitral ring calcification, failed annuloplasty with dysfunctional mitral ring or bio-prosthesis was associated to improved symptoms, quality of life and stable bioprosthesis function at 2-year followup. Between the first and second year, mitral valve in ring patients had higher mortality compared against patients with failed bio-prosthesis or severe calcification treated with balloon expandable valves.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: 2-Year Outcomes of Transcatheter Mitral Valve Replacement in Patients With Annular Calcification, Rings, and Bioprostheses.
Reference: Mackram F. Eleid, et al. J Am Coll Cardiol 2022;80:2171–2183.
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