Early Experience With Transcatheter Mitral Valve Replacement: A Systematic Review
Background Transcatheter mitral valve replacement (TMVR) has emerged as an alternative therapeutic option for the treatment of severe mitral regurgitation in patients with prohibitive or high surgical risk. The aim of this systematic review is to evaluate the clinical procedural characteristics and...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.013332 |
| _version_ | 1818776779427414016 |
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| author | David del Val Alfredo Nunes Ferreira‐Neto Jerome Wintzer‐Wehekind François Dagenais Jean‐Michel Paradis Mathieu Bernier Kim O'Connor Jonathan Beaudoin Afonso B. Freitas‐Ferraz Josep Rodés‐Cabau |
| author_facet | David del Val Alfredo Nunes Ferreira‐Neto Jerome Wintzer‐Wehekind François Dagenais Jean‐Michel Paradis Mathieu Bernier Kim O'Connor Jonathan Beaudoin Afonso B. Freitas‐Ferraz Josep Rodés‐Cabau |
| author_sort | David del Val |
| collection | DOAJ |
| description | Background Transcatheter mitral valve replacement (TMVR) has emerged as an alternative therapeutic option for the treatment of severe mitral regurgitation in patients with prohibitive or high surgical risk. The aim of this systematic review is to evaluate the clinical procedural characteristics and outcomes associated with the early TMVR experience. Methods and Results Published studies and international conference presentations reporting data on TMVR systems were identified. Only records including clinical characteristics, procedural results, and 30‐day and midterm outcomes were analyzed. A total of 16 publications describing 308 patients were analyzed. Most patients (65.9%) were men, with a mean age of 75 years (range: 69–81 years) and Society for Thoracic Surgery Predicted Risk of Mortality score of 7.7% (range: 6.1–8.6%). The etiology of mitral regurgitation was predominantly secondary or mixed (87.1%), and 81.5% of the patients were in New York Heart Association class III or IV. A transapical approach was used in 81.5% of patients, and overall technical success was high (91.7%). Postprocedural mean transmitral gradient was 3.5 mm Hg (range: 3–5.5 mm Hg), and only 4 cases (1.5%) presented residual moderate to severe mitral regurgitation. Procedural and all‐cause 30‐day mortality were 4.6% and 13.6%, respectively. Left ventricular outflow obstruction and conversion to open heart surgery were reported in 0.3% and 4% of patients, respectively. All‐cause and cardiovascular‐related mortality rates were 27.6% and 23.3%, respectively, after a mean follow‐up of 10 (range: 3 to 24) months. Conclusions TMVR was a feasible, less invasive alternative for treating severe mitral regurgitation in patients with high or prohibitive surgical risk. TMVR was associated with a high rate of successful valve implantation and excellent hemodynamic results. However, periprocedural complications and all‐cause mortality were relatively high. |
| first_indexed | 2024-12-18T11:18:21Z |
| format | Article |
| id | doaj.art-e57765edce1649baba879bba22ac77de |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-18T11:18:21Z |
| publishDate | 2019-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-e57765edce1649baba879bba22ac77de2022-12-21T21:09:52ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-09-0181710.1161/JAHA.119.013332Early Experience With Transcatheter Mitral Valve Replacement: A Systematic ReviewDavid del Val0Alfredo Nunes Ferreira‐Neto1Jerome Wintzer‐Wehekind2François Dagenais3Jean‐Michel Paradis4Mathieu Bernier5Kim O'Connor6Jonathan Beaudoin7Afonso B. Freitas‐Ferraz8Josep Rodés‐Cabau9Quebec Heart & Lung Institute Laval University Quebec City Quebec CanadaQuebec Heart & Lung Institute Laval University Quebec City Quebec CanadaQuebec Heart & Lung Institute Laval University Quebec City Quebec CanadaQuebec Heart & Lung Institute Laval University Quebec City Quebec CanadaQuebec Heart & Lung Institute Laval University Quebec City Quebec CanadaQuebec Heart & Lung Institute Laval University Quebec City Quebec CanadaQuebec Heart & Lung Institute Laval University Quebec City Quebec CanadaQuebec Heart & Lung Institute Laval University Quebec City Quebec CanadaQuebec Heart & Lung Institute Laval University Quebec City Quebec CanadaQuebec Heart & Lung Institute Laval University Quebec City Quebec CanadaBackground Transcatheter mitral valve replacement (TMVR) has emerged as an alternative therapeutic option for the treatment of severe mitral regurgitation in patients with prohibitive or high surgical risk. The aim of this systematic review is to evaluate the clinical procedural characteristics and outcomes associated with the early TMVR experience. Methods and Results Published studies and international conference presentations reporting data on TMVR systems were identified. Only records including clinical characteristics, procedural results, and 30‐day and midterm outcomes were analyzed. A total of 16 publications describing 308 patients were analyzed. Most patients (65.9%) were men, with a mean age of 75 years (range: 69–81 years) and Society for Thoracic Surgery Predicted Risk of Mortality score of 7.7% (range: 6.1–8.6%). The etiology of mitral regurgitation was predominantly secondary or mixed (87.1%), and 81.5% of the patients were in New York Heart Association class III or IV. A transapical approach was used in 81.5% of patients, and overall technical success was high (91.7%). Postprocedural mean transmitral gradient was 3.5 mm Hg (range: 3–5.5 mm Hg), and only 4 cases (1.5%) presented residual moderate to severe mitral regurgitation. Procedural and all‐cause 30‐day mortality were 4.6% and 13.6%, respectively. Left ventricular outflow obstruction and conversion to open heart surgery were reported in 0.3% and 4% of patients, respectively. All‐cause and cardiovascular‐related mortality rates were 27.6% and 23.3%, respectively, after a mean follow‐up of 10 (range: 3 to 24) months. Conclusions TMVR was a feasible, less invasive alternative for treating severe mitral regurgitation in patients with high or prohibitive surgical risk. TMVR was associated with a high rate of successful valve implantation and excellent hemodynamic results. However, periprocedural complications and all‐cause mortality were relatively high.https://www.ahajournals.org/doi/10.1161/JAHA.119.013332mitral valve diseasetranscatheter cardiac therapeuticstranscatheter mitral valve replacement |
| spellingShingle | David del Val Alfredo Nunes Ferreira‐Neto Jerome Wintzer‐Wehekind François Dagenais Jean‐Michel Paradis Mathieu Bernier Kim O'Connor Jonathan Beaudoin Afonso B. Freitas‐Ferraz Josep Rodés‐Cabau Early Experience With Transcatheter Mitral Valve Replacement: A Systematic Review Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease mitral valve disease transcatheter cardiac therapeutics transcatheter mitral valve replacement |
| title | Early Experience With Transcatheter Mitral Valve Replacement: A Systematic Review |
| title_full | Early Experience With Transcatheter Mitral Valve Replacement: A Systematic Review |
| title_fullStr | Early Experience With Transcatheter Mitral Valve Replacement: A Systematic Review |
| title_full_unstemmed | Early Experience With Transcatheter Mitral Valve Replacement: A Systematic Review |
| title_short | Early Experience With Transcatheter Mitral Valve Replacement: A Systematic Review |
| title_sort | early experience with transcatheter mitral valve replacement a systematic review |
| topic | mitral valve disease transcatheter cardiac therapeutics transcatheter mitral valve replacement |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.013332 |
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