Publication Date

8-1-2020

Journal

The Texas Heart Institute Journal

DOI

10.14503/THIJ-18-6650

PMID

33472225

Publication Date(s)

August 2020

Language

English

PMCID

PMC7819449

PubMedCentral® Posted Date

8-20-2020

PubMedCentral® Full Text Version

Post-Print

Published Open-Access

yes

Keywords

Disease-free survival, heart valve prosthesis implantation/methods, mitral valve insufficiency/physiopathology, mitral valve stenosis/therapy, postoperative complications/etiology, recovery of function, retrospective studies, survival rate, transcatheter mitral valve replacement/methods, treatment outcome

Abstract

Transcatheter mitral valve replacement is increasingly being used as a treatment for high-risk patients who have native mitral valve disease; however, no comprehensive studies on its effectiveness have been reported. We therefore searched the literature for reports on patients with native mitral valve disease who underwent transcatheter access treatment. We found 40 reports, published from September 2013 through April 2017, that described the cases of 66 patients (mean age, 71 ± 12 yr; 30 women; 30 patients with mitral stenosis, 34 with mitral regurgitation, and 2 mixed) who underwent transcatheter mitral valve replacement. We documented their baseline clinical characteristics, comorbidities, diagnostic imaging results, procedural details, and postprocedural results. Access was transapical in 41 patients and transseptal in 25. The 30-day survival rate was 82.5%. The technical success rate (83.3% overall) was slightly but not significantly better in patients who had mitral regurgitation than in those who had mitral stenosis. Transapical access procedures resulted in fewer valve-in-valve implantations than did transseptal access procedures (P=0.026). These current results indicate that transcatheter mitral valve replacement is feasible in treating native mitral disease. The slightly higher technical success rate in patients who had mitral regurgitation suggests that a valve with a specific anchoring system is needed when treating mitral stenosis. Our findings indicate that transapical access is more reliable than transseptal access and that securely anchoring the valve is still challenging in transseptal access.

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