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Clinical outcomes of transcatheter mitral valve replacement: two-year results of the CHOICE-MI Registry.

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology

Authors: Sebastian Ludwig, Nils Perrin, Augustin Coisne, Walid Ben Ali, Jessica Weimann, Alison Duncan, Mariama Akodad, Andrea Scotti, Daniel Kalbacher, Sabine Bleiziffer, Georg Nickenig, Jörg Hausleiter, Hendrik Ruge, Matti Adam, Anna Sonia Petronio, Nicolas Dumonteil, Lars Sondergaard, Marianna Adamo, Damiano Regazzoli, Andrea Garatti, Tobias Schmidt, Gry Dahle, Maurizio Taramasso, Thomas Walther, Joerg Kempfert, Jean-François Obadia, Omar Chehab, Gilbert H L Tang, Azeem Latib, Sachin S Goel, Neil P Fam, Martin Andreas, David W Muller, Paolo Denti, Fabien Praz, Ralph Stephan von Bardeleben, Juan F Granada, Thomas Modine, Lenard Conradi

BACKGROUND: Transcatheter mitral valve replacement (TMVR) using dedicated devices is an alternative therapy for high-risk patients with symptomatic mitral regurgitation (MR).

AIMS: This study aimed to assess the 2-year outcomes and predictors of mortality in patients undergoing TMVR from the multicentre CHOICE-MI Registry.

METHODS: The CHOICE-MI Registry included consecutive patients with symptomatic MR treated with 11 different dedicated TMVR devices at 31 international centres. The investigated endpoints included mortality and heart failure hospitalisation rates, procedural complications, residual MR, and functional status. Multivariable Cox regression analysis was applied to identify independent predictors of 2-year mortality.

RESULTS: A total of 400 patients, median age 76 years (interquartile range [IQR] 71, 81), 59.5% male, EuroSCORE II 6.2% (IQR 3.8, 12.0), underwent TMVR. Technical success was achieved in 95.2% of patients. MR reduction to ≤1+ was observed in 95.2% at discharge with durable results at 1 and 2 years. New York Heart Association Functional Class had improved significantly at 1 and 2 years. All-cause mortality was 9.2% at 30 days, 27.9% at 1 year and 38.1% at 2 years after TMVR. Chronic obstructive pulmonary disease, reduced glomerular filtration rate, and low serum albumin were independent predictors of 2-year mortality. Among the 30-day complications, left ventricular outflow tract obstruction, access site and bleeding complications showed the strongest impact on 2-year mortality.

CONCLUSIONS: In this real-world registry of patients with symptomatic MR undergoing TMVR, treatment with TMVR was associated with a durable resolution of MR and significant functional improvement at 2 years. Two-year mortality was 38.1%. Optimised patient selection and improved access site management are mandatory to improve outcomes.

PMID: 37235388

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