Outcomes After Transcatheter Mitral Valve Replacement in Valve in Valve, Valve in Ring, and Mitral Annular Calcification

TL;DR

This study compares the outcomes of a heart valve replacement procedure in patients with different types of valve issues, finding that one type has worse results.

Contribution

The study provides new insights into the comparative midterm outcomes of TMVR in ViV/ViR and ViM patients.

Findings

ViM patients had significantly higher early hospital mortality compared to ViV/ViR patients.

Midterm survival was significantly worse in the ViM group compared to the ViV/ViR group.

ViM procedure was independently associated with increased midterm mortality.

Abstract

There are few reports about midterm to long-term outcomes of transcatheter mitral valve replacement (TMVR) in valve in valve (ViV), valve in ring (ViR), and valve in mitral annular calcification (ViM). The aim of this study was to assess postoperative outcomes in patients who underwent TMVR for calcification or failing valves.

Between March 2016 and July 2024, 82 patients underwent TMVR with SAPIEN 3 (Edwards Lifescience) balloon-expandable valve, with 72 transseptal and 10 transapical access. Of 82 patients, 47 had TMVR with ViV/ViR and 35 with ViM. Postprocedural outcomes and midterm survivals were evaluated comparing ViV/ViR group with ViM group.

The ViM required more ventricular septal ablation before TMVR for left ventricular outflow tract obstruction (31.4% [11/35] vs 4.3% [2/47]; P < .01). Early hospital mortality was significantly higher in the ViM group (34.5% [12/35] vs 2.1% [1/47]; P < .01). The incidence of postprocedural stroke, left ventricular outflow tract obstruction, permanent pacemaker, and reintervention for mitral valve was similar between the 2 groups. The mean follow-up term was 17.6 ± 22.5 months. The cumulative 5-year survivals in ViV/ViR and ViM were 57.4% and 24.3%, respectively. A significant difference was noted in the midterm outcome between the 2 groups (P < .01). On multivariable Cox proportional hazards analysis, only conducting ViM procedure was associated with an increased midterm mortality (hazard ratio, 2.58; 95% CI, 1.33-4.99; P < .01).

Short-term and midterm outcomes of TMVR in ViV and ViR were better than those of ViM in this patient cohort.

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