Does Clinical Outcome Still Justify the Application of Transcatheter Mitral Valve in Valve or Valve in Ring Procedures?

Objectives: Transcatheter mitral valve in valve (TMViV) and mitral valve in ring (TMViR) implantation have become an alternative treatment option for high risk patients with previous mitral valve surgery. The focuses of previous studies in this high risk patient group were technical aspects and in hospital outcome, but information about the further clinical outcome are lacking. In addition differentiated information about the outcome in both groups is of particular clinical interest. We report our clinical experience with transcatheter mitral valve implantation using TMVIV or TMViR.

Methods: We analyzed all patients, who received a transcatheter mitral valve procedure using TMViV or TMViR .Baseline characteristics and initial clinical outcome were analyzed and further posthospital outcome evaluated.

Result: A total of 48 patients received transcatheter mitral valve procedures with a balloon-expanding valve, including 23 patients with TMViV (77 ± 6.1 years, ES 11.7 ± 7.6) and 25 patients with TMViR (74.6 ± 6.2 years, ES 17 ± 9.2). The transapical access was used in most procedures (83.3%). Mean postinterventional gradient were similar in both groups (6.22 ± 1.99 vs. 6.58 mm Hg ± 1.93, p = ns). Mild residual mitral valve insufficiency occurred in 30.4% of patients after TMViV vs. 76% after TMViR (p = 0.004). Two patients in the TMViR group demonstrated moderated insufficiency at hospital discharge. Postinterventional moderate/severe tricuspid insufficiency was 56.5% (TMViV) vs 40% (TMViR) (p = ns). In-hospital mortality was 0% in both groups and 1 year mortality rate was 17.4% (TMViV) vs. 36% (TMViR) (p = 0.005).

Conclusion: Clinical results after TMVIV and TMVIR are acceptable but are still associated with clinical limitations. These concern residual postinterventional mitral stenosis and insufficiency, which is in particular true for TMViR. Adequate patient selection is of utmost importance and alternative therapy strategies should be considered (MitralClip) with respect to ring related restrictions. In addition the high incidence of residual tricuspid insufficiency indicates the need for evaluation of additional procedures and close clinical follow-up.

Publication History

Article published online:
19 February 2021