1
|
Ben Ali W, Ludwig S, Duncan A, Weimann J, Nickenig G, Tanaka T, Coisne A, Vincentelli A, Makkar R, Webb JG, Akodad M, Muller DWM, Praz F, Wild MG, Hausleiter J, Goel SS, von Ballmoos MW, Denti P, Chehab O, Redwood S, Dahle G, Baldus S, Adam M, Ruge H, Lange R, Kaneko T, Leroux L, Dumonteil N, Tchetche D, Treede H, Flagiello M, Obadia JF, Walther T, Taramasso M, Søndergaard L, Bleiziffer S, Rudolph TK, Fam N, Kempfert J, Granada JF, Tang GHL, von Bardeleben RS, Conradi L, Modine T. Characteristics and outcomes of patients screened for transcatheter mitral valve implantation: 1-year results from the CHOICE-MI registry. Eur J Heart Fail 2022; 24:887-898. [PMID: 35338542 DOI: 10.1002/ejhf.2492] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 11/08/2022] Open
Abstract
AIMS Transcatheter mitral valve implantation (TMVI) represents a novel treatment option for patients with mitral regurgitation (MR) unsuitable for established therapies. The CHOICE-MI registry aimed to investigate outcomes of patients undergoing screening for TMVI. METHODS AND RESULTS From May 2014 to March 2021, patients with MR considered suboptimal candidates for transcatheter edge-to-edge repair (TEER) and at high risk for mitral valve surgery underwent TMVI screening at 26 centres. Characteristics and outcomes were investigated for patients undergoing TMVI and for TMVI-ineligible patients referred to bailout-TEER, high-risk surgery or medical therapy (MT). The primary composite endpoint was all-cause mortality or heart failure hospitalization after 1 year. Among 746 patients included (78.5 years, interquartile range [IQR] 72.0-83.0, EuroSCORE II 4.7% [IQR 2.7-9.7]), 229 patients (30.7%) underwent TMVI with 10 different dedicated devices. At 1 year, residual MR ≤1+ was present in 95.2% and the primary endpoint occurred in 39.2% of patients treated with TMVI. In TMVI-ineligible patients (n = 517, 69.3%), rates of residual MR ≤1+ were 37.2%, 100.0% and 2.4% after bailout-TEER, high-risk surgery and MT, respectively. The primary endpoint at 1 year occurred in 28.8% of patients referred to bailout-TEER, in 42.9% of patients undergoing high-risk surgery and in 47.9% of patients remaining on MT. CONCLUSION This registry included the largest number of patients treated with TMVI to date. TMVI with 10 dedicated devices resulted in predictable MR elimination and sustained functional improvement at 1 year. In TMVI-ineligible patients, bailout-TEER and high-risk surgery represented reasonable alternatives, while MT was associated with poor clinical and functional outcomes.
Collapse
Affiliation(s)
| | - Sebastian Ludwig
- University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK): Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Cardiovascular Research Foundation, New York City, NY, USA
| | | | - Jessica Weimann
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | | | | | | | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | | | | | - Mirjam G Wild
- Bern University Hospital, Bern, Switzerland
- Ludwig Maximilian University of Munich, Munich, Germany
| | | | | | | | | | | | | | - Gry Dahle
- Oslo University Hospital, Oslo, Norway
| | | | - Matti Adam
- University Hospital of Cologne, Cologne, Germany
| | | | | | | | - Lionel Leroux
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | | | - Hendrik Treede
- Heart Valve Center, Heart and Vascular Center, Universitätsmedizin Mainz, Mainz, Germany
| | - Michele Flagiello
- Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France
| | | | | | | | | | | | | | - Neil Fam
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Juan F Granada
- Cardiovascular Research Foundation, New York City, NY, USA
| | | | | | - Lenard Conradi
- University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK): Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Thomas Modine
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| |
Collapse
|
2
|
Sazzad F, Hon JKF, Ramanathan K, Nah JH, Ong ZX, Ti LK, Foo R, Tay E, Kofidis T. Design Variation, Implantation, and Outcome of Transcatheter Mitral Valve Prosthesis: A Comprehensive Review. Front Cardiovasc Med 2022; 8:782278. [PMID: 35284498 PMCID: PMC8907442 DOI: 10.3389/fcvm.2021.782278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/31/2021] [Indexed: 11/26/2022] Open
Abstract
The transcatheter mitral valve prosthesis is ideally suited for patients with inoperable mitral etiology. The transcatheter mitral valve implantation (TMVI) procedure has closely followed the evolution of transcatheter aortic procedures. There are considerable design variations amongst the limited TMVI prostheses currently available, and the implantation profiles of the devices are notably different. This comprehensive review will provide an overview of the current clinically tried TMVI devices with a focused outcome analysis. In addition, we have discussed the various design characteristics of TMVI and its associated failure mode, implantation technology, delivery methods, first-in-man trials, and pivotal trial summary for the synthesis of recent evidence.
Collapse
Affiliation(s)
- Faizus Sazzad
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore
- Cardiovascular Disease Translational Research Programme, Centre for Translational Medicine, National University of Singapore, Singapore, Singapore
- *Correspondence: Faizus Sazzad
| | - Jimmy Kim Fatt Hon
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore
- National University Heart Centre, National University Health System, Singapore, Singapore
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore
- National University Heart Centre, National University Health System, Singapore, Singapore
| | - Jie Hui Nah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zhi Xian Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lian Kah Ti
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Heart Centre, National University Health System, Singapore, Singapore
| | - Roger Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cardiovascular Disease Translational Research Programme, Centre for Translational Medicine, National University of Singapore, Singapore, Singapore
- National University Heart Centre, National University Health System, Singapore, Singapore
| | - Edgar Tay
- National University Heart Centre, National University Health System, Singapore, Singapore
- Asian Heart & Vascular Centre (AHVC), Mount Elizabeth Medical Centre, Singapore, Singapore
| | - Theo Kofidis
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore
- Cardiovascular Disease Translational Research Programme, Centre for Translational Medicine, National University of Singapore, Singapore, Singapore
- National University Heart Centre, National University Health System, Singapore, Singapore
| |
Collapse
|