The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Interventions for valvular disease and heart failure

Mitral regurgitation severity predicts one-year therapeutic benefit of Tendyne transcatheter mitral valve implantation

EuroIntervention 2019;15:e1065-e1071. DOI: 10.4244/EIJ-D-19-00333

1. West Virginia University, Morgantown, WV, USA; 2. Abbott Northwestern Hospital, Minneapolis, MN, USA; 3. Royal Brompton Hospital, London, United Kingdom; 4. MedStar Heart and Vascular Institute and Georgetown University School of Medicine, Washington, DC, 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, BC, Canada; 11. Beth Israel Deaconness Medical Center, Boston, MA, USA; 12. St. Vincent's Hospital, Darlinghurst, NSW, Australia

Aims: Longitudinal outcomes of transcatheter therapies for secondary mitral regurgitation (MR) have been variable. This study examined predictors of one-year outcome following transcatheter mitral valve implantation (TMVI) with the Tendyne device.

Methods and results: The first 100 consecutive patients with moderate-severe or severe MR enrolled in the Tendyne CE Mark trial were examined. Multivariable analyses assessed the impact of preoperative clinical and echocardiographic characteristics on one-year freedom from death or heart failure hospitalisation (HFH). 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 Class III/IV, age 75.6±7.5 years and Society of Thoracic Surgeons predicted risk of mortality of 8.5±6.1%. Increased left ventricular end-diastolic dimension was associated with one-year Tendyne benefit following univariate analysis (OR 0.35, p=0.010). Following multivariable adjustment, only severe MR, defined as a composite of effective regurgitant orifice area ≥0.3 cm2 or regurgitant volume ≥45 ml, was associated with freedom from death or HFH at one year (OR 0.16, p=0.032).

Conclusions: Preoperative severe MR was predictive of improved one-year outcome following Tendyne TMVI. These results may inform therapy selection for the management of secondary MR and left ventricular dilatation.

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