Key result
Transfemoral TMVR undergoes evaluation for clinical, echocardiographic, and functional outcomes in the international CHOICE-MI registry.
Why the study?
Data on transfemoral transcatheter mitral valve replacement devices for mitral regurgitation are limited.
Cohort (n=124)
Yes
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Access-site complications are a potential downside to transapical TMVR, but one of the pluses is the very predictable and durable elimination of mitral regurgitation. That seemed to be the case in our study at 30 days and this was sustained to 1 year. TMVR produced elimination, not just a reduction, of mitral regurgitation in the vast majority of patients, irrespective of their [MR] etiology. To us, it seems that TMVI may be a reasonable alternative for patients with severe symptomatic MR, who are considered unsuitable for standard mitral regurgitation therapies following a discussion with the heart team.”
“Regardless of MR etiology, TMVI was associated with high technical success, low procedural mortality, low rates of procedural complications, especially with the transseptal approach, durable MR elimination in the majority of patients, optimal results in MAC patients.”
“In the absence of randomized controlled trials, these results provide important preliminary evidence on the benefits of TMVR.”
In high-risk patients with mitral regurgitation, transfemoral transcatheter mitral valve replacement demonstrated high technical success (91.1%), low procedural mortality (0.8%), and durable MR reduction, though 2-year rates of mortality or heart failure hospitalization were 52.4%.
BACKGROUND: Transcatheter mitral valve replacement (TMVR) is an alternative for patients with mitral regurgitation (MR), but data on transfemoral (TF) devices are limited. OBJECTIVES: The aim of this study was to evaluate clinical, echocardiographic, and functional outcomes following TF TMVR in an international registry. METHODS: The CHOICE-MI (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency) Registry included patients undergoing TMVR with dedicated devices at 41 international centers. This analysis included only TF TMVR. Outcomes were assessed per Mitral Valve Academic Research Consortium criteria. Echocardiographic, functional, and clinical outcomes up to 2 years were reported. The primary endpoint was a composite of all-cause mortality or heart failure hospitalization at 2 years. Predictors were identified using multivariable Cox regression. RESULTS: A total of 124 patients (median age 79 years [Q1-Q3: 75-83 years], 50% women, median European System for Cardiac Operative Risk Evaluation II score 5.0% [Q1-Q3: 3.3-8.5]) underwent TF TMVR with 9 different devices. The leading MR etiology was primary MR (n = 49 [39.5%]), with mitral annular calcification in 12.9%. Technical success was achieved in 113 of 124 patients (91.1%), and procedural mortality was low (1 of 124 [0.8%]). Residual MR ≤1+ was achieved in 94.9% at discharge, with stable results at follow-up. The rates of cardiovascular mortality were 14.7% (95% CI: 7.9%-21.5%) and 20.3% (95% CI: 11.4%-29.1%) and of the primary endpoint 44.1% (95% CI: 30.6%-50.0%) and 52.4% (95% CI: 40.2%-62.1%) at 1 and 2 years, respectively, and NYHA functional class had significantly improved at 1- and 2-year follow-up. Atrial fibrillation was an independent predictor of the primary endpoint, whereas technical success was associated with survival. CONCLUSIONS: TMVR using dedicated TF devices demonstrates favorable safety, durable MR reduction, and sustained functional improvement in high-risk patients. (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency Registry [CHOICE-MI Registry]; NCT04688190).
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Strotmann et al. (2026) conducted a cohort in Mitral regurgitation (n=124). Transfemoral transcatheter mitral valve replacement (TF TMVR) was evaluated on Composite of all-cause mortality or heart failure hospitalization at 2 years (95% CI 40.2-62.1). Transfemoral transcatheter mitral valve replacement in high-risk patients with mitral regurgitation resulted in a 2-year rate of all-cause mortality or heart failure hospitalization of 52.4%.
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