Transseptal access for transcatheter mitral valve-in-valve or valve-in-ring implantation yielded significantly higher 3-year survival compared to transapical access (90.9% vs 35.5%, p=0.045).
Cohort (n=24)
Does transseptal access improve survival and procedural outcomes compared to transapical access in patients undergoing TMVIV or TMVIR for degenerated mitral bioprostheses or failed annuloplasty rings?
In patients undergoing transcatheter mitral valve-in-valve or valve-in-ring procedures, transseptal access is associated with significantly better long-term survival and improved cardiac output compared to transapical access.
Absolute Event Rate: 90.9% vs 35.5%
p-value: p=0.045
AIMS: The study sought to assess outcomes of transcatheter mitral valve-in-valve implantation (TMVIV) for degenerated bioprostheses and transcatheter mitral valve-in-ring implantation (TMVIR) for failed annuloplasty rings according to access route and the Mitral Valve Academic Research Consortium (MVARC) criteria. METHODS AND RESULTS: Twenty-four patients (72±13 years; eight men 33%) underwent TMVIV (n=14) or TMVIR (n=10) for mitral regurgitation (MR; n=17) or stenosis (n=7) using balloon-expandable bioprostheses. Transapical (TA) access was chosen in 13, and transseptal (TS) access in 11 patients. MVARC technical success, device success and procedural success were 95.8%, 41.7% and 33.3%, respectively, with no differences between access routes. Cardiac output (CO) increased significantly by 1.1±0.8 l/min in TS patients, but not in TA patients (ΔCO=0.0±0.5 l/min; p=0.0051). Overall three-year survival was estimated at 57.6% (95% confidence interval: 33.9-81.3; TA 35.5% 5.2-65.9; TS 90.9% 73.9-100). Survival up to four years according to vascular access showed a clear benefit in patients treated transseptally (p=0.045). CONCLUSIONS: Regardless of the access route, TMVIV/TMVIR was associated with high technical success yet impaired device success. In the long term, TA access had a significant adverse impact on survival.
Frerker et al. (Thu,) conducted a cohort in Degenerated mitral valve bioprostheses and failed annuloplasty rings (n=24). Transseptal access for TMVIV/TMVIR vs. Transapical access was evaluated on Three-year survival (p=0.045). Transseptal access for transcatheter mitral valve-in-valve or valve-in-ring implantation yielded significantly higher 3-year survival compared to transapical access (90.9% vs 35.5%, p=0.045).