Transcatheter mitral valve-in-ring (MViR) using third-generation balloon-expandable aortic transcatheter heart valves was associated with a significant reduction in mitral regurgitation (MR) and improvement in heart failure symptoms at one year, with the tradeoff of elevated valvular gradients and a high rate of reintervention, according to a recent study published in JACC: Cardiovascular Interventions.

Mayra E. Guerrero, MD, FACC, et al., analyzed data from the STS/ACC TVT Registry, including 820 patients (mean age 72.2 ± 10.4 years, 50.9% women, mean STS score 8.2% ± 6.9%, 78% NYHA functional class III to IV) from 236 sites who underwent MViR between August 2015 and December 2022. The study population had a mean left ventricular ejection fraction of 47.8% ± 14.2% and a mean mitral gradient of 8.9 ± 7.0 mm Hg, and 75.5% of patients had ≥moderate MR.

The procedure was performed via transseptal access in 93.9% of cases, and technical success was observed in 88% of cases. At 30-days post procedure, all-cause mortality was 8.3%.

Following up at one year, investigators found all-cause mortality increased to 22.4% and a reintervention rate of 9.1%. When evaluating symptom severity and quality of life, they noted 75.6% of patients were NYHA functional class I to II, Kansas City Cardiomyopathy Questionnaire scores increased by 25.9 ± 29.1 points, mean mitral valve gradient was 8.4 ± 3.4 mm Hg and 91.7% of patients had ≤mild MR.

“Transcatheter MViR is a reasonable alternative for high or extreme surgical risk patients who are unable to undergo surgery and have appropriate anatomy for the procedure,” write the authors. “Careful patient selection is essential to avoid procedure complications and poor outcomes.”

In an accompanying editorial comment, Paul Guedeney, MD, PhD, Olivier Barthelemy, MD, and Gilles Montalescot, MD, PhD, add, “Considering the patient profiles and the current results, we wonder whether this technique, diverted from its original indication, is a real innovation or just a palliative technique applied to patients too frail for surgery in the absence of a dedicated valvular device.”

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Heart Failure, Patient Selection, Registries, Mitral Valve, STS/ACC TVT Registry, National Cardiovascular Data Registries