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Long-Term Clinical and Hemodynamic Outcomes of Transcatheter Mitral Valve Replacement

Nicolas Groshenry1, Gaspard Suc2, Jules Mesnier2

  • 1Cardiology Department, Bichat Claude Bernard Hospital, Public, Paris, France; Université Paris City, Paris, France.

JACC. Cardiovascular Interventions
|January 28, 2026
PubMed

Insights

Transcatheter mitral valve replacement (TMVR) using balloon-expandable aortic prostheses shows favorable long-term clinical and hemodynamic outcomes. This study confirms acceptable durability with low rates of severe structural valve deterioration and valve failure.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Long-term outcomes of transcatheter mitral valve replacement (TMVR) using balloon-expandable aortic prostheses are not well-established.
  • Uncertainty exists regarding the durability and clinical efficacy of TMVR in diverse patient populations.

Purpose of the Study:

  • To evaluate the long-term clinical and hemodynamic outcomes of TMVR.
  • To assess the durability, structural valve deterioration (SVD), and TMVR failure rates.
  • To compare outcomes across different TMVR implantation scenarios (valve-in-valve, valve-in-ring, valve-in-mitral annular calcification).

Main Methods:

  • A retrospective analysis of 200 patients undergoing TMVR with balloon-expandable transcatheter heart valves, primarily via a trans-septal approach.
  • Primary outcome: composite of death or mitral reintervention. Secondary outcomes: mortality, hemodynamics, recurrent mitral regurgitation, SVD, and TMVR failure.
  • Median follow-up of 3.2 years.

Main Results:

  • Freedom from death or reintervention at 8 years was 20%. Outcomes were worse in valve-in-ring and valve-in-mitral annular calcification compared to valve-in-valve (P < 0.01).
  • Mean gradient increased slightly over time, and effective orifice area decreased modestly.
  • Severe SVD occurred in 7% of patients, and TMVR failure in 10%.

Conclusions:

  • TMVR with balloon-expandable aortic prostheses demonstrates favorable long-term clinical and hemodynamic results.
  • The procedure offers acceptable durability with low rates of severe structural valve deterioration and valve failure.
  • TMVR is a viable option for mitral valve replacement, though outcomes vary by implantation context.
Abstract

Keywords:
TMVRstructural valve deteriorationvalve durability

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