Key result
Patients with severe mitral regurgitation treated with optimal medical therapy following TMVR screening failure experienced high mortality, reaching 23.6% at 6 months and 35.7% at 1 year.
Why the study?
Due to high TMVR screening failure rates, many patients with severe MR remain on medical therapy alone, but data on their characteristics and outcomes are scarce.
What are the characteristics and mortality outcomes of patients with severe mitral regurgitation who are anatomically ineligible for TMVR and treated with medical therapy alone?
Cohort (n=30)
What are the characteristics and mortality outcomes of patients with severe mitral regurgitation who are anatomically ineligible for TMVR and treated with medical therapy alone?
Patients with severe mitral regurgitation who are anatomically ineligible for TMVR and treated medically face high mortality, highlighting an unmet need for device innovation to accommodate broader anatomies.
High 1-year mortality (36%) in TMVR-ineligible severe MR on OMT; leaves open need for broader-anatomy devices in prospective studies.
OBJECTIVES: Due to high rates of transcatheter mitral valve replacement (TMVR) screening failure, a substantial proportion of patients with severe mitral regurgitation (MR) remains on optimal medical treatment (OMT) only. Data on outcomes of these patients ineligible for mitral interventions are scarce. This study aimed to assess characteristics and outcomes of severe MR patients treated medically following TMVR screening failure. METHODS: From 2016-2020, a total of 111 patients with severe MR underwent screening for TMVR. Screening failure occurred in 66 cases. Among these, 30 patients were treated with OMT only. Characteristics of these patients were analyzed, Kaplan-Meier estimates calculated, and univariate regression analysis performed. Median follow-up time was 2.26 years (95% confidence interval, 1.24-3.25). RESULTS: Anatomical reasons for screening failure in the study cohort (n = 30) were left ventricular (LV) restraints, risk of LV outflow tract obstruction, mitral annulus calcification, and sizing issues. Median ejection fraction was 56.0% (interquartile range, 38.8%-60.0%). Concomitant tricuspid regurgitation and severe pulmonary hypertension were present in 36.7% and 46.2%, respectively. Intercommissural diameters ranged from 22.5-52.0 mm. Mortality was 23.6% after 6 months and 35.7% after 1 year. Factors associated with mortality were female sex, MR severity, ischemic MR, high N-terminal pro-brain natriuretic peptide levels, and small annulus diameters. CONCLUSIONS: Despite growing experience with TMVR, the subset of MR patients anatomically eligible for TMVR is small and many patients are treated medically. Mortality in these patients remains high, underlining an unmet need for adequate therapeutic alternatives. TMVR devices adapting to broader annular size ranges with smaller ventricular profiles might fill this gap.
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Ludwig et al. (2021) conducted a cohort in Severe mitral regurgitation (n=30). Optimal medical treatment (OMT) was evaluated on Mortality after 1 year. Patients with severe mitral regurgitation treated with optimal medical therapy following TMVR screening failure experienced high mortality, reaching 23.6% at 6 months and 35.7% at 1 year.
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