Transcatheter Mitral Valve Implantation and Surgical Mitral Valve Replacement in Intermediate Risk Patients—1-year Clinical Outcome

Background: Transcatheter mitral valve implantation (TMVI) is an evolving technology expanding therapeutic options for patients at higher operative risk. Data comparing TMVI to surgical mitral valve replacement (SMVR) are lacking.

Methods: Clinical outcome after TMVI with the Tendyne mitral valve and SMVR was compared after propensity score matching including seven variables (age, sex, BMI, atrial fibrillation, mitral valve pathology, previous CABG and SAVR, concomitant tricuspid regurgitation). Previously, clinical outcome at 30 days has been reported. The current study reports 1-year clinical outcome after TMVI and 1-year mortality of both cohorts.

Results: 40 TMVI patients were compared with 80 SMVR patients. Baseline characteristics included in the matching protocol were well balanced: age 78 years (IQR 75; 80) vs. 78 years (IQR 73; 80, p = 0.797), female sex 60% vs. 60% (p = 1.0), atrial fibrillation 68% vs. 64% (p = 0.839), previous CABG or SAVR 25% vs. 25% (p = 1.0), body mass index 26 ± 4 vs. 25 ± 4 (p = 0.723); mitral valve pathology: 70% regurgitation, 7.5% stenosis, and 22.5% mixed disease vs. 74%, 4%, and 23% (p = 0.649); and concomitant tricuspid regurgitation 35% vs. 30% (p = 0.678). 30-day mortality was similar in both groups (TMVI, n = 1, 2.5%; SMVR, n = 3, 3.75%, p = 0.47). Cause of death at 30 days was fatal stroke in the TMVI group and left heart failure in all three patients in the SMVR group. Kaplan Meier estimated survival at 1 year was comparable after TMVI (80 ± 6%, 95% CI 69–93) and SMVR (86 ± 4%, 95% CI 79–94, p = 0.18) with seven additional deaths beyond 30 days in the TMVI group and eight in the SMVR group. In the TMVI group there were two non-cardiovascular deaths from encephalitis and sepsis after hip replacement and five cardiovascular deaths. In the SMVR group, one patient died due to intestinal ischemia; in seven patients the cause of death is unknown. Echocardiography at 1-year follow-up was completed for all but one of 32 patients. Absence of mitral regurgitation (MR) or paravalvular leakage (PVL) was seen in 21 patients (65%), trace MR/PVL in 4 (13%), and mild MR/PVL in 6 patients (19%). Within 1 year after TMVI, 22 patients (55%) required rehospitalization for heart failure symptoms.

Conclusion: TMVI and SMVR in a propensity score matched cohort resulted in similar 1-year survival. TMVI achieved sustained MR elimination at 1 year.

Publikationsverlauf

Artikel online veröffentlicht:
11. Februar 2025