Five-Year Outcomes of Patients With Mitral Structural Valve Deterioration Treated With Transcatheter Valve in Valve Implantation - A Single Center Prospective Registry

Nili Schamroth Pravda; Raffael Mishaev; Amos Levi; Guy Witberg; Yaron Shapira; Katia Orvin; Yeela Talmor Barkan; Ashraf Hamdan; Ram Sharoni; Leor Perl; Alexander Sagie; Hana Vaknin Assa; Ran Kornowski; Pablo Codner

doi:10.3389/fcvm.2022.883242

Five-Year Outcomes of Patients With Mitral Structural Valve Deterioration Treated With Transcatheter Valve in Valve Implantation - A Single Center Prospective Registry

Front Cardiovasc Med. 2022 Apr 26:9:883242. doi: 10.3389/fcvm.2022.883242. eCollection 2022.

Affiliations

¹ Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel associated with Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
² Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
³ Cardio-Thoracic Surgery Department, Faculty of Medicine, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel.

Abstract

The Valve-in-Valve (ViV) technique is an emerging alternative for the treatment of bioprosthetic structural valve deterioration (SVD) in the mitral position. We report on intermediate-term outcomes of patients with symptomatic SVD in the mitral position who were treated by transcatheter mitral valve-in-valve (TM-ViV) implantation during the years 2010-2019 in our center. Three main outcomes were examined during the follow-up period: NYHA functional class, TM-ViV hemodynamic data per echocardiography, and mortality. Our cohort consisted of 49 patients (mean age 77.4 ± 10.5 years, 65.3% female). The indications for TM-ViV were mainly for regurgitant pathology (77.6%). All 49 patients were treated with a balloon-expandable device. The procedure was performed via transapical access in 17 cases (34.7%) and transfemoral vein/trans-atrial septal puncture in 32 cases (65.3%). Mean follow-up was 4.4 ± 2.0 years. 98% and 91% of patients were in NYHA I/II at 1 and 5 years, respectively. Mitral regurgitation was ≥moderate in 86.3% of patients prior to the procedure and this decreased to 0% (p < 0.001) following the procedure and was maintained over 2 years follow-up. The mean trans-mitral valve gradients decreased from pre-procedural values of 10.1 ± 5.1 mmHg to 7.0 ± 2.4 mmHg at 1 month following the procedure (p = 0.03). Mortality at 1 year was 16% (95%, CI 5-26) and 35% (95%, CI 18-49) at 5 years. ViV in the mitral position offers an effective and durable treatment option for patients with SVD at high surgical risk.

Keywords: mitral valve; outcomes; structural valve deterioration; transcatheter; valve-in-valve.