TY - JOUR

T1 - Clinical outcomes of transcatheter mitral valve replacement

T2 - two-year results of the CHOICE-MI Registry

AU - Ludwig, Sebastian

AU - Perrin, Nils

AU - Coisne, Augustin

AU - Ali, Walid Ben

AU - Weimann, Jessica

AU - Duncan, Alison

AU - Akodad, Mariama

AU - Scotti, Andrea

AU - Kalbacher, Daniel

AU - Bleiziffer, Sabine

AU - Nickenig, Georg

AU - Hausleiter, Jörg

AU - Ruge, Hendrik

AU - Adam, Matti

AU - Petronio, Anna S.

AU - Dumonteil, Nicolas

AU - Sondergaard, Lars

AU - Adamo, Marianna

AU - Regazzoli, Damiano

AU - Garatti, Andrea

AU - Schmidt, Tobias

AU - Dahle, Gry

AU - Taramasso, Maurizio

AU - Walther, Thomas

AU - Kempfert, Joerg

AU - Obadia, Jean François

AU - Chehab, Omar

AU - Tang, Gilbert H.L.

AU - Latib, Azeem

AU - Goel, Sachin

AU - Fam, Neil

AU - Andreas, Martin

AU - Muller, David W.

AU - Denti, Paolo

AU - Praz, Fabien

AU - Bardeleben, Ralph Stephan von

AU - Granada, Juan F.

AU - Modine, Thomas

AU - Conradi, Lenard

AU - CHOICE-MI Investigators (collaborators)

N1 - Publisher Copyright: © Europa Digital & Publishing 2023. All rights reserved.

PY - 2023

Y1 - 2023

N2 - 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.

AB - 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.

KW - access site

KW - miscellaneous

KW - mitral regurgitation

KW - transapical

KW - transseptal

U2 - 10.4244/EIJ-D-22-01037

DO - 10.4244/EIJ-D-22-01037

M3 - Journal article

C2 - 37235388

AN - SCOPUS:85168428698

VL - 19

SP - 512

EP - 525

JO - EuroIntervention

JF - EuroIntervention

SN - 1774-024X

IS - 6

ER -