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

Transcatheter Mitral Valve Replacement: Factors Associated with Screening Success and Failure.

DOI: 10.4244/EIJ-D-19-00444

1. CHU Lille, Heart Valve Clinic; European Genomic Institute for Diabetes (E.G.I.D), Lille, France; Univ Lille, Lille France; Inserm UMR 1011, Lille, France; Institut Pasteur de Lille, Lille, France, France
2. European Genomic Institute for Diabetes (E.G.I.D), Lille, France; Univ Lille, Lille, France; Inserm UMR 1011, Lille, France; Institut Pasteur de Lille, Lille, France; CHU Lille, Department of Radiology
3. Groupe Cardiovasculaire Interventionnel, Clinique Pasteur, Toulouse, France
4. CHU Lille, Heart Valve Clinic
5. CHU Lille, Department of Radiology
6. Groupe Cardiovasculaire Interventionnel, Clinique Pasteur, Toulouse, France
7. Groupe Cardiovasculaire Interventionnel, Clinique Pasteur, Toulouse, France
8. CHU Lille, Heart Valve Clinic
9. CHU Lille, Heart Valve Clinic
10. University of Liège Hospital, GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
11. CHU Lille, Heart Valve Clinic; European Genomic Institute for Diabetes (E.G.I.D), Lille, France; Univ Lille, Lille, France; Inserm UMR 1011, Lille, France; Institut Pasteur de Lille, Lille, France
12. Groupe Cardiovasculaire Interventionnel, Clinique Pasteur, Toulouse, France
13. CHU Lille, Heart Valve Clinic
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Aims:. Transcatheter mitral valve replacement (TMVR) is a promising therapeutic solution to treat high-risk patients with severe mitral regurgitation (MR) contraindicated to surgery. Optimal selection of patients who will benefit from the procedure is of paramount. We aimed at investigating factors associated with TMVR screening. 

Methods and results:. From November 2016 to July 2018, we examined conditions associated with TMVR screening success in patients referred to the two French Heart Valve Clinics with the greatest TMVR experience. Among a total of 40 consecutive screened patients, 16 (40%) were selected for TMVR (8 Twelve Intrepid, 7 Tendyne and 1 HighLife), while 24 patients (60%) were refused for TMVR mainly for too large mitral annulus (MA) (n=15,62% of refusal), or too small anatomy and risk of neo-left ventricular outflow tract (LVOT) obstruction (n=6,25% of refusal). Patients with suitable anatomy for TMVR were more often male and suffered more frequently from secondary MR (p=0.01) associated with previous myocardial infarction and presented commissure-to-commissure diameter lower than 39mm (AUC=0.72, p=0.0085) and LVESD larger than 32mm (AUC=0.83, p<0.0001) on transthoracic echocardiography and MA area lower than 17.6cm² (AUC=0.95, p<0.0001) and anteroposterior diameter higher than 41.6mm (AUC=0.87, p<0.001) on CT-scan. 

Conclusions:. Despite several prostheses available, most patients referred to Heart Valve Clinics and good candidate regarding their clinical profile cannot be implanted with TMVR because of mismatch between their anatomy and prosthesis characteristics. Our findings suggest the need to develop new prosthesis adapted to larger MA but with lower impact on the LVOT.

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