Clinical outcomes of transcatheter mitral valve replacement: two-year results of the CHOICE-MI Registry.

Abstract

Transcatheter mitral valve replacement (TMVR) using dedicated devices is an alternative therapy for high-risk patients with symptomatic mitral regurgitation (MR). This study aimed to assess the 2-year outcomes and predictors of mortality in patients undergoing TMVR from the multicentre CHOICE-MI Registry. The CHOICE-MI Registry included consecutive patients with symptomatic MR treated with 11different dedicated TMVR devices at 31 international centres. The investigated endpoints included mortality and heart failure hospitalisation rates, procedural complications, residual MR, and functional status. Multivariable Cox regression analysis was applied to identify independent predictors of 2-year mortality. Atotal of 400patients, median age 76 years (interquartile range [IQR] 71, 81), 59.5% male, EuroSCORE II 6.2% (IQR 3.8, 12.0), underwent TMVR. Technical success was achieved in 95.2% of patients. MR reduction to ≤1+ was observed in 95.2% at discharge with durable results at 1 and 2years. New York Heart Association Functional Class had improved significantly at 1 and 2years. All-cause mortality was 9.2% at 30days, 27.9% at 1year and 38.1% at 2years after TMVR. Chronic obstructive pulmonary disease, reduced glomerular filtration rate, and low serum albumin were independent predictors of 2-year mortality. Among the 30-day complications, left ventricular outflow tract obstruction, access site and bleeding complications showed the strongest impact on 2-year mortality. In this real-world registry of patients with symptomatic MR undergoing TMVR, treatment with TMVR was associated with adurable resolution of MR and significant functional improvement at 2years. Two-year mortality was 38.1%. Optimised patient selection and improved access site management are mandatory to improve outcomes.