Key result
TENDYNE TMVI linked to greater LVEDVI reduction and ~3 mmHg lower MV MPG versus traditional procedures.
Why the study?
The study aimed to compare TMVI using LV apical anchoring against traditional approaches, focusing on their impact on reverse remodeling and outcomes.
Does TMVI with LV apical anchoring (TENDYNE) improve LV reverse remodeling compared to traditional TMVI (valve-in-valve/valve-in-ring) in high-surgical risk patients with severe mitral regurgitation?
Cohort (n=55)
No
Does TMVI with LV apical anchoring (TENDYNE) improve LV reverse remodeling compared to traditional TMVI (valve-in-valve/valve-in-ring) in high-surgical risk patients with severe mitral regurgitation?
TMVI with the TENDYNE apical anchoring system promotes more favorable LV reverse remodeling and valve hemodynamics compared to traditional valve-in-valve/valve-in-ring procedures, though it induces a more spherical LV shape.
TMVI with TENDYNE was associated with greater LV reverse remodeling; leaves open clinical outcome benefits versus traditional TMVI.
Background Transcatheter mitral valve implantation (TMVI) using an anchoring system at the left ventricular (LV) apex has developed as treatment option for high-surgical risk patients with severe mitral regurgitation (MR). Purposes The aim of this study was to compare TMVI with LV apical anchoring to traditional approaches, focusing on their impact on reverse remodeling and outcomes. Methods Data of consecutive patents who underwent TMVI with TENDYNE prosthesis and TMVI as valve-in-valve and valve-in-ring procedures between 2015 and 2024 were compared regarding post-procedural changes in LV end-diastolic volume index (LVEDVI), left atrial volume index (LAVI), LV ejection fraction (LVEF), LV sphericity index (LVSI) and LVOT-obstruction based on cardiac computed tomography (CCT). Changes in mitral valve pressure gradient (MV MPG) and presence of paravalvular leakage (PVL) were assessed echocardiography. Results We analyzed data of patients who underwent TMVI with TENDYNE prosthesis (Group 1, n=26, mean age 77±7, 50% women) and TMVI as valve-in-valve and valve-in-ring procedures (Group 2, n=29, mean age 71±10, 41% women). LV EDVI decreased stronger in Group 1 (125±34 vs 102±31 ml/m2, p<0.001) then in Group 2 (101±26 vs 95±32ml/m2, p=0.155). Postprocedural reduction in LAVI was significant in both Groups (103 vs 85 ml/m2, p<0.001) and (85 vs 78 ml/m2, p=0.031). LVSI changes were stronger in Group 1 (0.5±0.1 vs 0.7±0.5, p=0.057) than in Group 2 (0.4±0.1 vs 0.4±0.5, p=0.248). LV EF decreased slightly in both Groups (42 vs 38%, p=0.003) and (55 vs 52%, p=0.003). MV MPG reduction was more pronounced in Group 1 (3.5±1.2 vs 6.9±3.2mmHg, p<0.001). LVOT obstruction was observed in 4 patients in Group 1 and in 7 patients in Group 2. The 30d mortality rate was numerically higher in Group 1 - 5/26 (19%) compared to Group 2 - 1/29 (3%) but without statistical significance (p=0.090). Conclusion We observed more favorable valve hemodynamics and LV reverse remodeling after TENDYNE procedure than after traditional procedures, however with more spherical shape of the LV. 30-day mortality did not differ significantly between both groups. Larger multicenter studies are needed to investigate the impact of LV geometric changes induced by different TMVI procedures on the long-term clinical outcomes.
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Solowjowa et al. (2026) conducted a cohort in Severe mitral regurgitation (MR) in high-surgical risk patients (n=55). TMVI with TENDYNE prosthesis (LV apical anchoring) vs. TMVI as valve-in-valve and valve-in-ring procedures was evaluated on 30-day mortality (p=0.090). TMVI with TENDYNE prosthesis showed more favorable LV reverse remodeling but a numerically higher 30-day mortality (19% vs 3%, p=0.090) compared to traditional valve-in-valve/ring procedures.
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