Transcatheter management of left-sided valvular heart disease following heart transplantation

Aortic stenosis (AS) and mitral regurgitation (MR) are rare in heart transplant (HTx) recipients, but their incidence increases with extended post-transplant survival. This study assesses the safety, efficacy and outcomes of transcatheter interventions in this high-risk population.

An institutional series of HTx patients undergoing a transcatheter aortic valve implant (TAVI) or mitral transcatheter edge-to-edge repair (M-TEER) from March 2015 through April 2024 was analysed retrospectively. Both elective cases and patients in cardiac decompensation/cardiogenic shock were included. There were no exclusion criteria. Primary outcomes were echocardiographic allograft function and Valve Academic Research Consortium 3 (VARC-3)/Mitral Valve Academic Research Consortium (MVARC) success and safety composite end points. Secondary outcomes included symptom change, complications and survival.

A total of 15 consecutive patients were included in the analysis. Nine patients underwent TAVI and 6 had M-TEER. The median age was 56 years, with a median of 17 years from HTx to valve intervention. A total of 46.7% (7/15) of the procedures were considered urgent/emergency. Improvements were noted in the left ventricular ejection fraction, systolic pulmonary artery pressure and tissue Doppler peak contraction velocity. The VARC-3/MVARC technical success was 100%; device success for TAVI was 93.3% and 83.3% for M-TEER. VARC-3 early safety was 66.7% for TAVI, and MVARC procedural success was 83.3% for M-TEER; 86.7% showed improved functional status. Median survival was 800 days.

TAVI and M-TEER were feasible and efficient in improving echocardiographic allograft function. Elective procedures were associated with a median survival of over 2 years. Survival outcomes varied based on procedure urgency. Close monitoring of AS/MR seems crucial in HTx patients, with timely intervention prior to decompensation/shock. Further multicentre studies are needed to establish management guidelines for AS/MR in HTx recipients.