Transapical transcatheter mitral valve replacement for mitral valve disease: an Iberian experience

• Published in: Revista española de cardiología (English ed.) 2024-07
• Main Authors: Gutiérrez-Ortiz, Eva, Cobiella, Javier, Muñoz-Guijosa, Christian, Teles, Rui C., Estévez-Loureiro, Rodrigo, Moñivas, Vanessa, Regueiro, Ander, Blasco-Turrión, Sara, Mahía, Patricia, Figuereo Beltre, Danela, Freitas, Pedro, Piñón, Miguel, Amat-Santos, Ignacio J, Julià Amill, Ignasi, Nolasco, Tiago, Pereda, Daniel, Martín López, Carlos, Nombela-Franco, Luis
• Format: Article
• Language: English
• Subjects: Enfermedad de la válvula mitral; Insuficiencia mitral; Mitral regurgitation; Mitral valve disease; Reemplazo percutáneo de la válvula mitral; Sistema Tendyne; Tendyne system; Transcatheter mitral valve implantation; Transcatheter mitral valve replacement
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/j.rec.2024.07.004

Transcatheter mitral valve replacement (TMVR) is an emerging treatment alternative for mitral valve (MV) disease in patients who were ineligible for surgical intervention or edge-to-edge repair. This study aimed to assess the short- and mid-term outcomes of this procedure. We conducted a prospective registry to include the initial experience with symptomatic, consecutive patients who underwent TMVR using the transapical Tendyne system at 7 centers in the Iberian Peninsula. Baseline clinical and imaging data, periprocedural information, and follow-up assessments were collected at 1 month and 1 year. A total of 40 patients (mean age 78.5 years [76-82], 47,5% males) underwent TMVR. The majority had significant surgical risk, comorbidities, and advanced functional class. All patients had significant mitral regurgitation (MR), except for 2 with severe stenosis. Previous MV intervention and off-label indication for the procedure were present in 4 (10.0%) and 8 (20.0%) patients, respectively. Technical success was recorded in 100%, device success in 95.0%, and procedural success in 85.0% at 30-day. All-cause mortality was 2.5% and 17.5% at the 1-month and 1-year follow-up, respectively. MR reduction (≤ 1) and functional class improvement (NYHA I-II) were observed at 1 year in 93.9% and 87.9% of survivors, respectively. Treatment with TMVR produced enduring resolution of MV disease and notable functional enhancement at 1 year of follow-up. The procedure demonstrated a satisfactory early safety profile, although 1-year mortality remained relatively high in this high-risk population. El reemplazo percutáneo de la válvula mitral (RPVM) es una alternativa emergente para el tratamiento de la enfermedad de la válvula mitral (VM) en pacientes que no son candidatos a intervención quirúrgica o reparación de borde a borde. Este estudio tiene como objetivo evaluar los resultados a corto y medio plazo de este procedimiento. Se realizó un registro prospectivo para incluir la experiencia inicial con pacientes sintomáticos consecutivos que se sometieron a RPVM con el sistema transapical Tendyne en 7 centros de la península ibérica. Se recopilaron datos clínicos y de imágenes basales, información perioperatoria y evaluaciones de seguimiento a 1 mes y 1 año. Un total de 40 pacientes —media de edad, 78,5 (intervalo, 76-82) años, el 47,5% varones— se sometieron a RPVM. La mayoría presentaba un riesgo quirúrgico significativo, comorbilidades y una clase funcional avanzada. Todos los