Transcatheter Mitral Valve Implantation Compared to Surgery: One-Year Clinical Outcome

Transcatheter mitral valve implantation (TMVI) is an evolving technology, expanding therapeutic options for patients at higher operative risk. Data comparing TMVI to surgical mitral valve replacement (SMVR) are lacking.

Clinical outcomes after TMVI with the Tendyne mitral valve and SMVR were compared utilizing propensity score matching, including seven variables. The current study reports 1-year clinical outcomes after TMVI and 1-year mortality in both cohorts.

Forty TMVI patients were compared to 80 SMVR patients. Baseline characteristics included in the matching protocol were well balanced: Age (78 years [interquartile range, IQR 75; 80] vs. 78 years [IQR 73; 80], p = 0.797), female sex (60% vs. 60% [p = 1.0]), atrial fibrillation (68% vs. 64% [p = 0.839]), previous coronary artery bypass grafting (CABG) or surgical aortic valve replacement (25% vs. 25% [p = 1.0]), body mass index (kg/m²; 26 ± 4 vs. 25 ± 4 [p = 0.723]), mitral valve pathology (regurgitation 70% vs. 74%, stenosis 7.5% vs. 4%, and mixed disease 22.5% vs. 23% [p = 0.649]), and concomitant tricuspid regurgitation (35% vs. 30% [p = 0.678]). Thirty-day mortality was similar in both groups (TMVI, n = 1, 2.5%; SMVR, n = 3, 3.75%, p = 0.47). Kaplan-Meier estimated survival at 1 year was comparable after TMVI (80 ± 6% [95% CI 69-93%]) and SMVR (86 ± 4% [95% CI 79-94%], p = 0.18) with seven additional deaths beyond 30 days in the TMVI group and eight in the SMVR group. In the TMVI group, two were non-cardiovascular deaths for encephalitis and sepsis after hip replacement, and five were cardiovascular deaths. In the SMVR group, one patient died due to intestinal ischemia, and in seven patients, the cause of death is unknown. At 1 year, in all TMVI patients, echocardiography showed ≤mild paravalvular regurgitation. Within 1 year after TMVI, 21 patients (52.5%) required rehospitalization for heart failure symptoms.

TMVI and SMVR in a propensity score-matched cohort displaying an intermediate surgical risk resulted in similar 1-year survival. TMVI achieved a sustained MR elimination at 1 year, and 80% of patients presented in the New York Heart Association (NYHA) class I or II.