2-Year Outcomes after Transcatheter Mitral Valve Replacement: Results from the CHOICE-MI Registry

Background: Transcatheter mitral valve replacement (TMVR) using dedicated devices is an alternative therapy for high-risk patients with mitral regurgitation (MR). This study aimed to assess 2-year outcomes and predictors of mortality in patients undergoing TMVR from the CHOICE-MI multicenter registry.

Method: The CHOICE-MI registry included consecutive patients with symptomatic MR treated with 11 different dedicated TMVR devices at 31 international centers. Investigated endpoints included mortality and heart failure hospitalization 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 (age: 76 years [IQR: 71, 81], 59.5% male, EuroSCORE II: 6.2% [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. Functional class improved significantly at 1 and 2 years. All-cause mortality rates were 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 30-day complications, left ventricular outflow tract obstruction, access site, and bleeding complications showed the strongest impact on 2-year mortality.

Conclusion: In this real-world registry of patients with symptomatic MR undergoing TMVR, treatment with TMVR was associated with durable resolution of MR and significant functional improvement at 2 years. Two-year mortality was 38%. Optimized patient selection and improved access site management are mandatory to improve outcomes.

Publication History

Article published online:
28 January 2023