Search Results (2)

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. Full article

Transcatheter mitral valve implantation (TMVI) is used for treating severe mitral valve regurgitation in patients deemed unsuitable for open-heart surgery. However, delays between preoperative workup and therapy can lead to changes in the clinical condition and structural valve findings, necessitating a meticulous reevaluation of diagnostic and therapeutic options. Case Presentation: A 77-year-old woman with severe mitral valve regurgitation and severe comorbidities was referred to our Heart Team and was deemed suitable for TMVI based on the initial evaluation. The echocardiographic finding showed a severe degenerative mitral valve regurgitation with prolapse of the A3 and P3 segments and an eccentric jet directed posteriorly to the atrial roof but without the complete picture of Barlow’s disease. Due to delayed approval by the patient, the therapeutic procedure was postponed. Subsequent echocardiographic reevaluation six months later revealed a hypermobile anterior mitral leaflet resulting from chordal elongation in conjunction with a septal bulge, raising the risk for postoperative left ventricular outflow tract (LVOT) obstruction. To mitigate this risk, TMVI combined with the Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction (LAMPOON) was performed. Post-implantation echocardiography revealed a well-functioning mitral valve prosthesis without para- and transvalvular leak, a mean gradient of 3 mm Hg, and no LVOT obstruction. Conclusions: The diagnostic and therapeutic evaluation of TMVI remains intricate and time-consuming, necessitating thorough planning. Prompt performance of the procedure is crucial to prevent unforeseen structural changes that could jeopardize the patient’s outcome. The combination of TMVI with the LAMPOON technique for preventing LVOT obstruction appears feasible and suitable for selected patients. Full article