Long-term clinical and hemodynamic outcomes of transcatheter mitral valve replacement

Abstract Background Long-term results of transcatheter mitral valve replacement (TMVR) using balloon-expandable aortic prostheses remain uncertain. Purpose This study aims to evaluate long-term clinical and hemodynamic outcomes in patients undergoing TMVR. Method All patients undergoing TMVR in our center were included. A balloon-expandable transcatheter heart valve (THV) was used in all cases. The transseptal approach was the default route. Patients were followed at 1, 6, 12 months and yearly thereafter, having an echocardiogram at each visit. The primary outcome was a composite of death or mitral reintervention defined as new mitral valve replacement (surgical or transcatheter), or heart transplantation. Secondary outcomes included all-cause mortality, changes in mean trans-mitral gradient and in mitral effective orifice area (EOA) over time, recurrence of mitral regurgitation, incidence of severe structural valve deterioration (SVD) and TMVR failure at last follow-up. Severe TMVR structural valve deterioration (SVD) was defined as new severe mitral regurgitation or stenosis, after exclusion of other dysfunction causes. TMVR failure was defined as valve-related symptoms, reintervention or death. Results 200 patients underwent TMVR with 121 (61%) valve-in-valve (ViV), 45 (23%) valve-in-ring (ViR) and 34 (17%) valve in mitral annulus calcification (ViMAC) procedures. The median age of the population was 70 52-80 years and 67% were women. The median follow-up period was 3.2 years 1.2-6.8 years and 46 patients (23%) were followed over 5 years. Freedom from death or mitral reintervention, at 1-, 5- and 8- years, was respectively 82%, 48% and 20%. This primary outcome occurred more frequently in the ViR and ViMAC groups than in the ViV group (p0.01). The mean transmitral gradient remained stable during follow-up (6 5-8 mmHg vs 7 6-9 mmHg at discharge and at 8 years, respectively, p=0.16). Occurrence of mitral regurgitation ≥ 3 /4 was infrequent (6%). Severe SVD occurred in 14 patients (7%) with a mean time of 5.5±0.7 years. Twenty (10%) patients developed TMVR failure (mean time 4.9±0.6 years), 12 requiring reintervention. Conclusion This study suggests good long-term clinical outcomes and acceptable durability of TMVR using aortic prosthesis, with low incidence of severe SVD and valve failure.Cumulative risk of death and severe SVD Hemodynamic outcomes after TMVR