Structural heart : the journal of the Heart Team · 2025
Transcatheter Mitral Valve Replacement Using Contemporary Dedicated Devices: A Systematic Review and Meta-Analysis.
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Zorman Mark J, Dangas Katerina, Vibhishanan Jonathan, Castle James, Eastwick-Jones Kate, Coronelli Marco, Alabdaljabar Mohamad S, Foster Kaleb, Silva Danuzia, Patel Parth, Johns Emma, Piankova Palina, Ordóñez-Mena José, Dawkins Sam, Newton James, Eleid Mackram F, Guerrero Mayra E, Cahill Thomas J
Аннотация
BACKGROUND: Dedicated transcatheter mitral valve replacement (TMVR) devices have emerged as a promising strategy for treating mitral regurgitation (MR) in high-risk patients with complex native valve anatomy. Early experience spans multiple devices utilizing both transapical and transseptal access. The aim of this study was to evaluate procedural, 30-day, and midterm outcomes of TMVR with contemporary dedicated mitral devices in patients with native MR.
METHODS: A systematic search of Medline, Embase, and Cochrane Library (January 2010-January 2025) was conducted. Pooled outcome estimates were derived using random-effects models, excluding legacy devices and cases of mitral stenosis.
RESULTS: Thirteen studies (914 patients) were included in the analysis. The mean age was 75.4 years, and 69.8% had functional or mixed MR. Technical success was 96.3%. Residual MR was mild or less in 99% of patients at 30 days and 98% at 1 year. All-cause mortality was 11.0% at 30 days and 26.4% at 1 year. Over a mean follow-up of 12.1 months, rates of heart failure (HF) hospitalizations, cerebrovascular events, and valve reinterventions were 26.2, 5.6, and 6.0 events per 100 patient-years, respectively. Compared with transseptal access, transapical showed higher 30-day major bleeding (19.2% vs. 10.4%, p = 0.03) and all-cause mortality at 30 days (14.0% vs. 4.7%, p <0.001) and 1 year (27.7% vs. 13.1%, p = 0.005). Midterm rates of HF readmissions, major bleeding, and valve reinterventions were comparable between access routes.
CONCLUSIONS: Contemporary dedicated TMVR devices demonstrate high technical success and sustained MR reduction. Transseptal access is associated with lower morbidity and mortality. Further research is needed to improve longer-term mortality and HF hospitalizations following TMVR with dedicated mitral devices.
METHODS: A systematic search of Medline, Embase, and Cochrane Library (January 2010-January 2025) was conducted. Pooled outcome estimates were derived using random-effects models, excluding legacy devices and cases of mitral stenosis.
RESULTS: Thirteen studies (914 patients) were included in the analysis. The mean age was 75.4 years, and 69.8% had functional or mixed MR. Technical success was 96.3%. Residual MR was mild or less in 99% of patients at 30 days and 98% at 1 year. All-cause mortality was 11.0% at 30 days and 26.4% at 1 year. Over a mean follow-up of 12.1 months, rates of heart failure (HF) hospitalizations, cerebrovascular events, and valve reinterventions were 26.2, 5.6, and 6.0 events per 100 patient-years, respectively. Compared with transseptal access, transapical showed higher 30-day major bleeding (19.2% vs. 10.4%, p = 0.03) and all-cause mortality at 30 days (14.0% vs. 4.7%, p <0.001) and 1 year (27.7% vs. 13.1%, p = 0.005). Midterm rates of HF readmissions, major bleeding, and valve reinterventions were comparable between access routes.
CONCLUSIONS: Contemporary dedicated TMVR devices demonstrate high technical success and sustained MR reduction. Transseptal access is associated with lower morbidity and mortality. Further research is needed to improve longer-term mortality and HF hospitalizations following TMVR with dedicated mitral devices.