TMVR—The Kiel experience

Background: Transcatheter mitral valve replacement (TMVR) is an emerging treatment strategy for multimorbid patients with severe mitral regurgitation.

Methods: Our retrospective analysis includes 6 patients who underwent TMVR in our heart center between April 2021 and October 2022. Patients were followed up for 12 to 18 months with clinical, electro- and echocardiographic examination at 1, 6 and 12 months postoperatively as well as CT- or MR-imaging.

Results: The mean age was 75 ± 3.7 years, one third of patients was female. Patients suffered from mild to moderate heart failure (NYHA II-III) and featured high surgical risk (STS-Score > 12%). Four of the six patients had undergone at least one prior cardiac surgery; one was a transapical re-redo surgery. There were no deaths intra-procedurally or within the first three months. Two patients died within the study period. One death was due to right ventricular failure, the other due to pleural empyema and sepsis. One patient had to undergo surgical removal of the TMVR prosthesis and mitral valve replacement due to endocarditis as a consequence of pyelonephritis four months after TMVR. Persistent MR reduction was achieved in all patients. There was no relevant mitral stenosis (MPG 5 mmHg) and no paravalvular leakage or LVOT obstruction at 6 or 12 months postoperatively. After an initial decrease in LVEF of 15%, a continuous improvement was seen within the first year. Clinical improvement in the form of a reduction in NYHA class and an increase in walking distance was observed, with comorbidities such as concomitant tricuspid regurgitation playing a role.

Conclusion: TMVR is a valuable treatment strategy for multimorbid patients with severe mitral regurgitation. It offers a safe and effective approach for relief of mitral valve regurgitation, even where transapical redo surgery is required.

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Artikel online veröffentlicht:
13. Februar 2024