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Transmitral Gradients and Mortality Following Transseptal Transcatheter Mitral Valve in Valve

Amr E Abbas1, Raj Makkar2, Amar Krishnaswamy3

  • 1Corewell Health East, William Beaumont University Hospital, Royal Oak, Michigan, USA.

JACC. Cardiovascular Interventions
|April 15, 2026
PubMed
Abstract

Insights

Low transvalvular mitral gradients (<4 mm Hg) after transcatheter mitral valve in valve (MVIV) procedures are linked to reduced cardiac output and increased long-term mortality. Discharge gradients should not solely determine outcomes without considering cardiac output.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Transcatheter mitral valve in valve (MVIV) procedures are increasingly common.
  • Echocardiographic transvalvular mitral gradients (TMGs) are used to assess outcomes after MVIV.
  • Limited data exists on the association between TMGs and clinical outcomes post-MVIV.

Purpose of the Study:

  • To investigate the relationship between discharge and 30-day TMGs and mortality following MVIV.
  • To evaluate the association between TMGs and other clinical outcomes post-MVIV.

Main Methods:

  • Utilized data from the Society of Thoracic Surgeons/American College of Cardiology TVT Registry (August 2015-March 2024).
  • Employed Cox proportional hazards regression models with cubic spline functions to analyze TMGs and all-cause mortality.
  • Categorized TMGs into low (<4 mm Hg), intermediate (4-7 mm Hg), and high (>7 mm Hg).
  • Generated Kaplan-Meier estimates for mortality and composite endpoints, comparing TMG ranges at discharge and 30 days.

Main Results:

  • Included 5,401 MVIV patients with a median follow-up of 377 days.
  • Low TMG (<4 mm Hg) was associated with lower cardiac output and cardiac index compared to intermediate and high TMGs.
  • Low discharge TMG correlated with increased 3-year all-cause mortality hazard (aHR: 1.52) versus intermediate TMG and (aHR: 1.35) versus high TMG.
  • Discharge and 30-day TMG measurements showed variability and should not be used interchangeably.

Conclusions:

  • TMG <4 mm Hg post-MVIV is linked to reduced cardiac output and increased 3-year mortality.
  • Significant changes in TMG occur between discharge and 30 days post-MVIV.
  • Discharge TMG alone is insufficient to determine procedural success or valve performance; cardiac output must be considered.
Keywords:
mitral valve in valvetranscatheter mitral valve replacementtransvalvular mitral gradient

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