Transcatheter mitral valve replacement (TMVR) with the Tendyne prosthesis resulted in favorable left-sided chamber remodeling in the majority of patients treated, as detected on computed tomographic angiography (CTA) at one month after implantation, according to a study presented as a poster during ESC Congress 2020 and simultaneously published in JACC: Cardiovascular Interventions. The study also showed that CTA identifies favorable post-TMVR changes, which could be related to specific characteristics of the device implantation.

Miho Fukui, MD, PhD, et al., used CTA to assess the anatomic and functional changes in left-sided chambers from baseline to one month after TMVR with the Tendyne prosthesis in a substudy of 36 patients who had participated in a feasibility study of the Tendyne mitral valve system or received it under compassionate use between 2015 and 2018. The median age of the patients in the substudy was 74 years, most (78%) were men, and 86% had secondary mitral regurgitation.

Results showed there were significant decreases in left ventricular (LV) end-diastolic volume (281 ml vs. 239 ml; p<0.001), LV ejection fraction (37% vs. 30%; p<0.001), LV mass (126 g vs. 116 g; p<0.001), left atrial volume (171 ml vs. 159 ml; p=0.027), and global longitudinal strain (–11% vs. –9%; p<0.001) from baseline to one-month follow-up.

In addition, the researchers found that favorable LV end-diastolic volume reverse remodeling occurred in 30 of 36 patients, and that closer proximity of the Tendyne apical pad to the true apex (24 mm vs. 35 mm) was predictive of favorable remodeling (p=0.037).

"These findings could have potential implications for expanding the role of CTA to optimize patient outcomes, selection, and implantation characteristics for the Tendyne system and the field of TMVR," the researchers conclude.

In an accompanying editorial comment, Michael Nabauer, MD, and Mathias Orban, MD, note that "the findings of Fukui et al. are a snapshot only one month after the procedure and need to be validated at longer follow-up times and by clinical outcome parameters." They add, "Whether there is a favorable pad location in terms of LVRR [left ventricular reverse remodeling] that affects symptomatic improvement and long-term mortality, remains to be seen."

Clinical Topics: Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Nuclear Imaging, Mitral Regurgitation

Keywords: ESC20, ESC Congress, Mitral Valve Insufficiency, Mitral Valve, Feasibility Studies, Stroke Volume, Ventricular Remodeling, Tomography, Prosthesis Implantation, Prostheses and Implants, Angiography, Heart Atria

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