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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

An Imaging-Based Marker to Refine Risk Stratification for Transcatheter Mitral Valve Replacement

by
Liliane Zillner
1,
Mirjam G. Wild
2,
Michaela M. Hell
3,
Harald Herkner
4,
Elmar W. Kuhn
5,
Tanja Rudolph
6,
Thomas Walther
7,
Lenard Conradi
8,
Andreas Zierer
9,
Francesco Maisano
10,
Marco Russo
11,
Fabrizio Rosati
12,
Andrea Colli
13,
Miguel Piñón
14,
David Reineke
15,
Gaby Aphram
16,
Tillmann Kerbel
1,
Christophe Dubois
17,
Jörg Hausleiter
2,18,
Ralph Stephan von Bardeleben
3,
Markus Mach
1,
Christian Loewe
19 and
Martin Andreas
1,*add Show full author list remove Hide full author list
1
Department of Cardiac and Thoracic Aortic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
2
Medizinische Klinik I, LMU University Hospital, 80336 Munich, Germany
3
Department of Cardiology, University Medical Center Mainz, 55131 Mainz, Germany
4
Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
5
Department of Cardiothoracic Surgery, Heart Center, University Hospital Cologne, 50937 Cologne, Germany
6
Department of Cardiology, Heart and Diabetes Center Northrhine-Westfalia, Bad Oeynhausen, Ruhr University Bochum, 32545 Bochum, Germany
7
Department of Cardiac Surgery, University Hospital Frankfurt, 60598 Frankfurt, Germany
8
Department of Cardiac Surgery, Heart Center, University Hospital Cologne, 50937 Cologne, Germany
9
Department for Cardiac, Vascular and Thoracic Surgery, Johannes Kepler University Linz, Kepler University Hospital, 4020 Linz, Austria
10
Valve Center, IRCCS Ospedale San Raaffaele and University Vita Salute, 20132 Milano, Italy
11
Department of Cardiac Surgery and Heart Transplantation, Azienda Ospedaliera San Camillo Forlanini, 00152 Rome, Italy
12
Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
13
Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
14
Servicio Cirugía Cardíaca, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
15
Department of Cardiac Surgery, Inselspital University Hospital Bern, 3010 Bern, Switzerland
16
Department of Cardiovascular and Thoracic Surgery. Cliniques Universitaires Saint Luc, 1200 Brussels, Belgium
17
Department of Cardiovascular Medicine, University Hospital Leuven and Department of Cardiovascular Sciences, 3000 Leuven, Belgium
18
DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 80636 Munich, Germany
19
Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
 
add Show full affiliation list
 
remove Hide full affiliation list
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(13), 4412; https://doi.org/10.3390/jcm14134412
Submission received: 30 April 2025 / Revised: 23 May 2025 / Accepted: 17 June 2025 / Published: 20 June 2025
(This article belongs to the Special Issue Mitral Valve Surgery: Current Status and Future Challenges)
Versions Notes

Abstract

Background: The Tendyne™ transcatheter heart valve (THV) system is a promising option for high-risk patients with severe mitral regurgitation (MR) who are ineligible for surgery or transcatheter edge-to-edge repair (TEER). As most fatal complications occur within the first 90 days, this study aimed to identify anatomical predictors of in-hospital mortality after transcatheter mitral valve replacement (TMVR). Methods: In this subanalysis of the TENDER registry, data from 110 patients who underwent TMVR across 26 centers between January 2020 and June 2022 were evaluated. Preprocedural imaging parameters were analyzed, including transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and cardiac 4D computed tomography (CT). Results: We identified LVEDDi as a significant predictor of in-hospital mortality (p = 0.022), with lower values in non-survivors (26.42 ± 3.76 mm/m2) than in survivors (30.37 ± 5.58 mm/m2). Both indexed and absolute LVEDDi predicted in-hospital complications (p < 0.001 and p = 0.008). In multivariate analysis, LVEDDi (p = 0.048; OR = 0.856) and STS score (p = 0.038; OR = 1.114) remained independent predictors of in-hospital mortality. In an extended model, only LVEDDi persisted as a significant predictor (p = 0.007), highlighting its robustness. Conclusions: This analysis identified a small LVEDDi as a novel, clinically relevant risk factor in TMVR and showed its added value alongside conventional markers. Its easy calculation supports incorporating LVEDDi thresholds into screening to improve patient selection and outcomes.
Keywords: transcatheter mitral valve replacement (TMVR); left ventricular end-diastolic diameter index (LVEDDi); Tendyne™ valve system transcatheter mitral valve replacement (TMVR); left ventricular end-diastolic diameter index (LVEDDi); Tendyne™ valve system

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MDPI and ACS Style

Zillner, L.; Wild, M.G.; Hell, M.M.; Herkner, H.; Kuhn, E.W.; Rudolph, T.; Walther, T.; Conradi, L.; Zierer, A.; Maisano, F.; et al. An Imaging-Based Marker to Refine Risk Stratification for Transcatheter Mitral Valve Replacement. J. Clin. Med. 2025, 14, 4412. https://doi.org/10.3390/jcm14134412

AMA Style

Zillner L, Wild MG, Hell MM, Herkner H, Kuhn EW, Rudolph T, Walther T, Conradi L, Zierer A, Maisano F, et al. An Imaging-Based Marker to Refine Risk Stratification for Transcatheter Mitral Valve Replacement. Journal of Clinical Medicine. 2025; 14(13):4412. https://doi.org/10.3390/jcm14134412

Chicago/Turabian Style

Zillner, Liliane, Mirjam G. Wild, Michaela M. Hell, Harald Herkner, Elmar W. Kuhn, Tanja Rudolph, Thomas Walther, Lenard Conradi, Andreas Zierer, Francesco Maisano, and et al. 2025. "An Imaging-Based Marker to Refine Risk Stratification for Transcatheter Mitral Valve Replacement" Journal of Clinical Medicine 14, no. 13: 4412. https://doi.org/10.3390/jcm14134412

APA Style

Zillner, L., Wild, M. G., Hell, M. M., Herkner, H., Kuhn, E. W., Rudolph, T., Walther, T., Conradi, L., Zierer, A., Maisano, F., Russo, M., Rosati, F., Colli, A., Piñón, M., Reineke, D., Aphram, G., Kerbel, T., Dubois, C., Hausleiter, J., ... Andreas, M. (2025). An Imaging-Based Marker to Refine Risk Stratification for Transcatheter Mitral Valve Replacement. Journal of Clinical Medicine, 14(13), 4412. https://doi.org/10.3390/jcm14134412

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