https://doi.org/10.1007/s00392-025-02625-4
1Deutsches Herzzentrum der Charite (DHZC) Klinik für Herz-, Thorax- und Gefäßchirurgie Berlin, Deutschland; 2Deutsches Herzzentrum der Charite (DHZC) Kardiologie, Angiologie und Intensivmedizin Berlin, Deutschland; 3Charité - Universitätsmedizin Berlin Klinik für kardiovaskuläre Chirurgie Berlin, Deutschland; 4Deutsches Herzzentrum der Charite (DHZC) Klinik für Kardiologie, Angiologie und Intensivmedizin | CBF Berlin, Deutschland
Background
Transcatheter mitral valve implantation (TMVI) using an anchoring system at the left ventricular (LV) apex has developed as treatment option for high-surgical risk patients with severe mitral regurgitation (MR). The aim of this study was to compare TMVI with LV apical anchoring to traditional approaches, focusing on their impact on reverse remodeling and outcomes.
Methods
Data of consecutive patents who underwent TMVI with TENDYNE prosthesis and TMVI as valve-in-valve and valve-in-ring procedures between 2015 and 2024 were compared regarding post-procedural changes in LV end-diastolic volume index (LVEDVI), left atrial volume index (LAVI), LV ejection fraction (LVEF), LV sphericity index (LVSI) and LVOT-obstruction based on cardiac computed tomography (CCT). Changes in mitral valve pressure gradient (MV MPG) and presence of paravalvular leakage (PVL) were assessed echocardiography.
Results
We analyzed data of patients who underwent TMVI with TENDYNE prosthesis (Group 1, n=26, mean age 77±7, 50% women) and TMVI as valve-in-valve and valve-in-ring procedures (Group 2, n=29, mean age 71±10, 41% women). LV EDVI decreased stronger in Group 1 (125±34 vs 102±31 ml/m2, p<0.001) then in Group 2 (101±26 vs 95±32ml/m2, p=0.155). Postprocedural reduction in LAVI was significant in both Groups (103 vs 85 ml/m2, p<0.001) and (85 vs 78 ml/m2, p=0.031). LVSI changes were stronger in Group 1 (0.5±0.1 vs 0.7±0.5, p=0.057) than in Group 2 (0.4±0.1 vs 0.4±0.5, p=0.248). LV EF decreased slightly in both Groups (42 vs 38%, p=0.003) and (55 vs 52%, p=0.003). MV MPG reduction was more pronounced in Group 1 (3.5±1.2 vs 6.9±3.2mmHg, p<0.001). LVOT obstruction was observed in 4 patients in Group 1 and in 7 patients in Group 2. The 30d mortality rate was numerically higher in Group 1 - 5/26 (19%) compared to Group 2 - 1/29 (3%) but without statistical significance (p=0.090).
Conclusion
We observed more favorable valve hemodynamics and LV reverse remodeling after TENDYNE procedure than after traditional procedures, however with more spherical shape of the LV. 30-day mortality did not differ significantly between both groups. Larger multicenter studies are needed to investigate the impact of LV geometric changes induced by different TMVI procedures on the long-term clinical outcomes.