Long-term outcomes of transcatheter mitral valve replacement using a balloon expandable valve
Eng MH, Kargoli F, Frisoli TM, Wang DD, Lee JC, Villablanca P, Guerrero M, Greenbaum A, So CY, Kang G, Wyman JF, and O'Neill WW. Long-term outcomes of transcatheter mitral valve replacement using a balloon expandable valve. Journal of the American College of Cardiology 2020; 75(11):1307.
J Am Coll Cardiol
Background Transcatheter mitral valve replacement (TMVR) using commercially available balloon expandable valves via a percutaneous, transseptal access has previously been reported but only short-term outcomes have been discussed. Long-term outcomes of this percutaneous strategy should be elucidated. Methods From 1/2013-12/2018, retrospective review of all percutaneous TMVR using the Edwards Lifesciences, Sapien family of valves was reviewed. Clinical characteristics, procedure outcomes, and ambulatory clinic interactions were abstracted. Survival according to procedure type (valve-in-valve (ViV), valve-in-ring (ViR) and valve-in-mitral annuluar calcification (ViMAC)) was calculated using the Kaplan-Meier (KM) method. Results A total of 65 TMVR cases were performed between 2013-2018, some as part of the MITRAL trial. Using KM analysis, the 2 year survival approximates 50% and by 5 years, almost all of the patients have died (p=0.2579). Conclusion Despite the relatively lower risk of ViV procedures, this population did exhibit survival advantages compared to ViR and ViMAC. The TMVR population is a sick elderly cohort and this series bears the limitations of retrospective research and observations of the early learning curve of performing a complex procedure. Further investigation is warranted to better select patients.