Transcatheter mitral valve implantation in complex anatomies: Outcomes after prior repair or aborted interventions

Patients with recurrent mitral valve disease after prior repair or persistent disease following an aborted edge-to-edge repair attempt face high risks with conventional surgery. The outcomes of transcatheter mitral valve implantation (TMVI) in these distinct cohorts remain unclear.

This retrospective single-center study included all patients undergoing Tendyne-TMVI between June 2020 and December 2024 for recurrent mitral valve disease after TEER, SMA, balloon valvuloplasty, or persistent mitral valve disease after aborted TEER. Outcomes were assessed using MVARC criteria.

Of 85 TMVI procedures, 16 were included (median age 80 years (IQR 70-83); STS 6.9% (IQR 5.6-8.2)). Prior interventions were SMA (37.5%), TEER (12.5%), balloon valvuloplasty (6.2%) and aborted TEER (43.8%). Technical success was 93.8%. At discharge, all patients showed none/trace residual mitral or paravalvular regurgitation, with a mean gradient of 3.9 ± 1.1 mmHg. At 30 days, one patient presented with severe paravalvular regurgitation due to atrialization of the prosthetic valve; no stroke occurred. Acute renal failure requiring dialysis occurred in 18.8%, one major bleeding and rehospitalization for heart failure in 12.5%. Thirty-day mortality was 12.5%. NYHA class improved significantly from 3 to 2 (p = 0.042). MVARC device success at 30 days was 63%. Estimated 1- and 2-year survival was 67% and 56% with 50% of deaths being non-cardiovascular.

In carefully selected high-risk patients with recurrent or persistent mitral valve disease, Tendyne TMVI achieved durable prosthetic mitral valve function, leading to significant symptomatic improvement. Failure to meet device success was mainly driven by mean mitral gradients exceeding 5 mmHg.