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Transapical mitral valve implantation for treatment of symptomatic mitral valve disease: a real-world multicentre experience.

European journal of heart failure

Authors: Mirjam G Wild, Felix Kreidel, Michaela M Hell, Fabien Praz, Markus Mach, Matti Adam, David Reineke, Hendrik Ruge, Sebastian Ludwig, Lenard Conradi, Tanja K Rudolph, Sabine Bleiziffer, Jörg Kellermair, Andreas Zierer, Georg Nickenig, Marcel Weber, Anna Sonia Petronio, Cristina Giannini, Gry Dahle, Kjell A Rein, Augustin Coisne, André Vincentelli, Christophe Dubois, Alison Duncan, Cesare Quarto, Axel Unbehaun, Ignacio Amat-Santos, Javier Cobiella, Nicolas Dumonteil, Rodrigo Estevez-Loureiro, Andrea Fumero, Tobias Geisler, Philipp Lurz, Antonio Mangieri, Vanessa Monivas, Thilo Noack, Luis Nombela Franco, Miguel A Pinon, Lukas Stolz, Didier Tchétché, Thomas Walter, Bernhard Unsöld, Stephan Baldus, Martin Andreas, Jörg Hausleiter, Ralph S von Bardeleben

AIMS: Transcatheter mitral valve implantation (TMVI) is a new treatment option for patients with symptomatic mitral valve (MV) disease. Real-world data have not yet been reported. This study aimed to assess procedural and 30-day outcomes of TMVI in a real-world patient cohort.

METHOD AND RESULTS: All consecutive patients undergoing implantation of a transapically delivered self-expanding valve at 26 European centres from January 2020 to April 2021 were included in this retrospective observational registry. Among 108 surgical high-risk patients included (43% female, mean age 75 ± 7 years, mean STS-PROM 7.2 ± 5.3%), 25% was treated for an off-label indication (e.g. previous MV intervention or surgery, mitral stenosis, mitral annular calcification). Patients were highly symptomatic (New York Heart Association [NYHA] functional class III/IV in 86%) and mitral regurgitation (MR) was graded 3+/4+ in 95% (38% primary, 37% secondary, and 25% mixed aetiology). Technical success rate was 96%, and MR reduction to ≤1+ was achieved in all patients with successful implantation. There were two procedural deaths and 30-day all-cause mortality was 12%. At early clinical follow-up, MR reduction was sustained and there were significant reductions of pulmonary pressure (systolic pulmonary artery pressure 52 vs. 42 mmHg, p < 0.001), and tricuspid regurgitation severity (p = 0.013). Heart failure symptoms improved significantly (73% in NYHA class I/II, p < 0.001). Procedural success rate according to MVARC criteria was 80% and was not different in patients treated for an off-label indication (74% vs. 81% for off- vs. on-label, p = 0.41).

CONCLUSION: In a real-world patient population, TMVI has a high technical and procedural success rate with efficient and durable MR reduction and symptomatic improvement.

© 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

PMID: 35064722

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