Mitral Regurgitation Severity Predicts One Year Therapeutic Benefit of Tendyne Transcatheter Mitral Valve Implantation
Vinay Badhwar1; Paul Sorajja2; Alison Duncan3; Vinod Thourani4; Ulrich Schaefer5; Paul Grayburn6; Nicolas Dumonteil7; Vasilis Babaliaros8; Andrea Garatti9; Jonathon Leipsic10; Michael Chuang11; Philipp Blanke12; David Muller13;
1. West Virginia University, Morgantown, WV, USA, UNITED STATES 2. Abbott Northwestern Hospital, Minneapolis, MN, USA 3. Royal Brompton Hospital, London, UK 4. MedStar Heart and Vascular Institute and Georgetown University School of Medicine, Washington, D.C., USA 5. University Heart Center Hamburg, Hamburg, Germany 6. Baylor Research Institute, Dallas, TX, USA 7. Clinique Pasteur, Toulouse, France 8. Emory University School of Medicine, Atlanta, GA, USA 9. IRCCS Policlinico San Donato, Milano, Italy 10. St. Paul’s Hospital, University of British Columbia, Vancouver, Canada 11. Beth Israel Deaconness Medical Center, Boston, MA, USA 12. St. Paul’s Hospital, University of British Columbia, Vancouver, Canada 13. St. Vincent's Hospital, Darlinghurst, NSW, Australia
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Aims: Longitudinal outcomes of transcatheter therapies for secondary mitral regurgitation (MR) have been variable. This study examined predictors of 1-year outcome following transcatheter mitral valve implantation (TMVI) with the Tendyne device.
Methods: The first 100 consecutive patients with severe MR enrolled in the Tendyne CE Mark trial were examined. Multivariable analyses assessed the impact of preoperative clinical and echocardiographic characteristics on 1-year freedom from death or heart failure hospitalization (HFH).
Results: All 100 patients underwent Tendyne TMVI without operative mortality. Univariate analysis was performed on implanted subjects, followed by multivariate analysis in those with complete predictive variable data. Patient characteristics: 76.5% male, 60.8% NYHA III/IV, age 75.6±7.5 years and Society of Thoracic Surgeons risk of mortality of 8.5±6.1%. Increased left ventricular end-diastolic dimension was associated with 1-year Tendyne benefit following univariate analysis (OR 0.35, p=0.010). Following multivariable adjustment, only severe MR, defined by a composite of effective regurgitant orifice area ≥0.3cm2 or regurgitant volume ≥45ml, was associated with freedom from death or HFH at 1-year (OR 0.16, p=0.032).
Conclusions:Preoperative severe MR was predictive of improved 1-year outcome following Tendyne TMVI. These results may inform a therapeutic gap for the management of secondary MR and left ventricular dilatation.