弁置換術における経カテーテル僧帽弁置換術（TMVR）の転帰：弁・弁置換術、弁・輪置換術、および僧帽弁輪石灰化

There are few reports about midterm to long-term outcomes of transcatheter mitral valve replacement (TMVR) in valve in valve (ViV), valve in ring (ViR), and valve in mitral annular calcification (ViM). The aim of this study was to assess postoperative outcomes in patients who underwent TMVR for calcification or failing valves.

Between March 2016 and July 2024, 82 patients underwent TMVR with SAPIEN 3 (Edwards Lifescience) balloon-expandable valve, with 72 transseptal and 10 transapical access. Of 82 patients, 47 had TMVR with ViV/ViR and 35 with ViM. Postprocedural outcomes and midterm survivals were evaluated comparing ViV/ViR group with ViM group.

The ViM required more ventricular septal ablation before TMVR for left ventricular outflow tract obstruction (31.4% [11/35] vs 4.3% [2/47]; P < .01). Early hospital mortality was significantly higher in the ViM group (34.5% [12/35] vs 2.1% [1/47]; P < .01). The incidence of postprocedural stroke, left ventricular outflow tract obstruction, permanent pacemaker, and reintervention for mitral valve was similar between the 2 groups. The mean follow-up term was 17.6 ± 22.5 months. The cumulative 5-year survivals in ViV/ViR and ViM were 57.4% and 24.3%, respectively. A significant difference was noted in the midterm outcome between the 2 groups (P < .01). On multivariable Cox proportional hazards analysis, only conducting ViM procedure was associated with an increased midterm mortality (hazard ratio, 2.58; 95% CI, 1.33-4.99; P < .01).

Short-term and midterm outcomes of TMVR in ViV and ViR were better than those of ViM in this patient cohort.