Emergent transcatheter mitral valve implantation: Early and mid-term outcomes - 20/07/23
, Marina Urena a, b, c, Caroline Chong-Nguyen a, Eric Brochet a, Grégory Ducrocq a, b, c, Bernard Iung a, b, c, Dominique Himbert a, b
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Highlights |
• | Limited data on urgent/emergent TMVI outcomes in haemodynamically unstable patients. |
• | Procedural success rates similar regardless of degree of urgency of TMVI procedure. |
• | Emergent/salvage TMVI has higher early mortality rate than elective or urgent TMVI. |
• | Landmark analysis suggests 30-day survivors have the same mid-term mortality. |
• | Results should encourage consideration of transseptal TMVI in this setting. |
• | This applies whatever the degree of urgency of the procedure. |
Abstract |
Background |
Transcatheter mitral valve implantation (TMVI) may be attractive to treat high-risk patients with mitral bioprosthesis or annuloplasty ring failure or severe mitral annular calcification.
Aim |
To report the outcomes of patients after valve-in-valve/ring/mitral annular calcification TMVI using balloon expandable transcatheter aortic valves, according to the degree of urgency of the procedure.
Methods |
All patients who underwent TMVI in our centre from 2010 to 2021 were classified into three groups: elective, urgent or emergent/salvage TMVI.
Results |
A total of 157 patients were included: 129 (82.2%) had elective, 21 (13.4%) urgent and 7 (4.4%) had emergent/salvage TMVI. Patients with emergent/salvage TMVI had a higher EuroSCORE II: elective, 7.3%; urgent, 9.7%; emergent/salvage, 54.5% (P<0.0001). The indication for TMVI was bioprosthesis failure in all of the emergent/salvage group, in 13 of the urgent group (61.9%) and in 62 of the elective group (48.1%). Overall, the technical success rate of TMVI was 86%, and was similar in the three groups (elective, 86.1%; urgent, 95.2%; emergent/salvage, 71.4%). The cumulative survival rate at 2-year follow-up was lower in the emergent/salvage group than in the elective or urgent group (42.9% vs 71.2% for the elective group; 76.2% for the urgent group; log-rank test, P=0.012). The excess mortality in the emergent/salvage group occurred during the first month postprocedure. Thereafter, the 30-day landmark analysis did not show any more statistical difference between the three groups (log-rank test, P=0.94).
Conclusions |
Emergent/salvage TMVI was associated with high early mortality, but 1-month survivors had similar outcomes to patients with elective/urgent TMVI. The degree of urgency of the procedure should not prevent TMVI in high-risk patients.
Le texte complet de cet article est disponible en PDF.Keywords : Transcatheter mitral valve implantation, Bioprosthesis failure, Emergency, Cardiogenic shock
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| ☆ | Tweet: Emergent/salvage TMVI is associated with high early mortality, but 1-month survivors have similar outcomes to patients with elective/urgent TMVI. The degree of urgency of the procedure should not prevent TMVI in high-risk patients. |
Vol 116 - N° 6-7
P. 300-308 - juin 2023 Retour au numéro
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