Comparative Study of Transcatheter Mitral Valve Implantation with Left Ventricular Apical Anchoring and Traditional Approaches: Impact on Reverse Remodeling and Outcomes

Background: Transcatheter mitral valve implantation (TMVI) using an anchoring system at the left ventricular (LV) apex allows for prosthesis fixation while replacing a dysfunctional native mitral valve. While previous studies have shown favorable LV reverse remodeling, comparative data with traditional TMVI without an apical tether remain limited. Hence, the aim of this retrospective study was to compare TMVI with LV apical anchoring to traditional approaches, focusing on their impact on reverse remodeling and outcomes.

Methods: A comparative analysis was conducted between TMVI using a LV apical anchoring system (n = 26) and traditional TMVI approaches, including valve-in-valve and valve-in-ring procedures (n = 29). Patient data, including clinical evaluations, echocardiographic measurements, and computed tomography findings, were collected and analyzed pre- and post-procedure.

Results: Indexed end-diastolic volume decreased significantly after TMVI with LV anchoring (125 ± 34 vs. 102 ± 31 mL/m², p < 0.001). However, indexed end-diastolic volume did not change significantly after traditional TMVI (101 ± 26 vs. 95 ± 32 mL/m², p = 0.155). Pressure gradient across the mitral valve was significantly lower following TMVI with LV anchoring compared with traditional TMVI (3.5 ± 1.2 vs. 6.9 ± 3.2 mmHg, p < 0.001). After TMVI with LV anchoring, diastolic LV long axis diameter decreased significantly (9.6 ± 0.9 vs. 8.4 ± 1.6 cm, p < 0.001), while diastolic LV sphericity did not change significantly (0.5 ± 0.1 vs. 0.7 ± 0.5, p = 0.057). However, diastolic LV sphericity index was higher after TMVI with LV anchoring than after traditional TMVI (0.7 ± 0.5 vs. 0.4 ± 0.1, p < 0.001). The 30-day mortality rate was numerically higher following TMVI with LV anchoring 5/26 (19%) compared with TMVI 1/29 (3%) but without statistical significance (p = 0.090).

Conclusion: A favorable LV reverse remodeling was observed after TMVI with LV anchoring, whereas this effect was not seen following traditional TMVI. Additionally, TMVI with LV anchoring demonstrated more favorable hemodynamics compared with traditional TMVI. However, TMVI with LV anchoring also induces geometrical alterations such as a shortening and a more spherical shape of the LV. The 30-day mortality did not differ significantly between the groups. Nonetheless, larger multicenter studies are needed to investigate the impact of LV geometric changes induced by TMVI using LV anchoring, particularly focusing on the long-term clinical outcomes related to the apical tether.

NB: This abstract was presented in a similar form at a previous meeting.

Publication History

Article published online:
11 February 2025