Long-Term Clinical and Hemodynamic Outcomes of Transcatheter Mitral Valve Replacement

BACKGROUND Long-term outcomes of transcatheter mitral valve replacement (TMVR) with balloon-expandable aortic prostheses remain uncertain. OBJECTIVES The aim of this study was to evaluate long-term clinical and hemodynamic outcomes after TMVR. METHODS All patients undergoing TMVR at the authors' center were included. Balloon-expandable transcatheter heart valves were implanted in all cases, usually using a trans-septal approach. The primary outcome was a composite of death or mitral reintervention (surgical or transcatheter replacement or transplantation). Secondary outcomes included mortality, hemodynamic changes, recurrent mitral regurgitation, structural valve deterioration (SVD), and TMVR failure. RESULTS A total of 200 patients underwent TMVR: 60.5% (121 of 200) valve-in-valve, 22.5% (45 of 200) valve-in-ring, and 17% (34 of 200) valve-in-mitral annular calcification. The median age was 70 years (Q1-Q3: 52-80 years), and 67% were women (134 of 200). Median follow-up was 3.2 years (Q1-Q3: 1.2-6.8 years). Freedom from death or reintervention at 1, 5, and 8 years was 82% (95% CI: 77%-88%), 48% (95% CI: 40%-56%), and 20% (95% CI: 11%-29%), respectively, with worse outcomes in valve-in-ring and valve-in-mitral annular calcification compared with valve-in-valve (P < 0.01). Mean gradient increased slightly over time (+0.25 ± 0.07 mm Hg/y; P < 0.01), with a modest decrease in effective orifice area (-0.04 cm2/y; P < 0.01). Significant recurrent mitral regurgitation occurred in 5.5% of patients (11 of 200). Seven percent (14 of 200) developed severe SVD after 5.3 (Q1-Q3: 3.5-7.4 years), and 10% (20 of 200) developed TMVR failure after 4.4 (Q1-Q3: 1.8-6.7 years). CONCLUSIONS TMVR with balloon-expandable aortic prostheses provides favorable long-term outcomes and acceptable durability, with low rates of severe SVD and valve failure.