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Characteristics and Outcomes of Patients Ineligible for Transcatheter Mitral Valve Replacement (TMVR): Implications for Future Device Innovation

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Characteristics and Outcomes of Patients Ineligible for Transcatheter Mitral Valve Replacement (TMVR): Implications for Future Device Innovation. / Ludwig, Sebastian; Koell, Benedikt; Sedighian, Roya; Weimann, Jessica; Schofer, Niklas; Schäfer, Andreas; Voigtländer, Lisa; Waldschmidt, Lara; Schirmer, Johannes; Seiffert, Moritz; Pecha, Simon; Westermann, Dirk; Reichenspurner, Hermann; Blankenberg, Stefan; Lubos, Edith; Conradi, Lenard; Kalbacher, Daniel.

In: J INVASIVE CARDIOL, Vol. 33, No. 4, 04.2021, p. E294-E301.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Ludwig, S, Koell, B, Sedighian, R, Weimann, J, Schofer, N, Schäfer, A, Voigtländer, L, Waldschmidt, L, Schirmer, J, Seiffert, M, Pecha, S, Westermann, D, Reichenspurner, H, Blankenberg, S, Lubos, E, Conradi, L & Kalbacher, D 2021, 'Characteristics and Outcomes of Patients Ineligible for Transcatheter Mitral Valve Replacement (TMVR): Implications for Future Device Innovation', J INVASIVE CARDIOL, vol. 33, no. 4, pp. E294-E301.

APA

Ludwig, S., Koell, B., Sedighian, R., Weimann, J., Schofer, N., Schäfer, A., Voigtländer, L., Waldschmidt, L., Schirmer, J., Seiffert, M., Pecha, S., Westermann, D., Reichenspurner, H., Blankenberg, S., Lubos, E., Conradi, L., & Kalbacher, D. (2021). Characteristics and Outcomes of Patients Ineligible for Transcatheter Mitral Valve Replacement (TMVR): Implications for Future Device Innovation. J INVASIVE CARDIOL, 33(4), E294-E301.

Vancouver

Ludwig S, Koell B, Sedighian R, Weimann J, Schofer N, Schäfer A et al. Characteristics and Outcomes of Patients Ineligible for Transcatheter Mitral Valve Replacement (TMVR): Implications for Future Device Innovation. J INVASIVE CARDIOL. 2021 Apr;33(4):E294-E301.

Bibtex

@article{3b2b157fe28b4d0cbb8c4c44a3d4c3a8,
title = "Characteristics and Outcomes of Patients Ineligible for Transcatheter Mitral Valve Replacement (TMVR): Implications for Future Device Innovation",
abstract = "OBJECTIVES: Due to high rates of transcatheter mitral valve replacement (TMVR) screening failure, a substantial proportion of patients with severe mitral regurgitation (MR) remains on optimal medical treatment (OMT) only. Data on outcomes of these patients ineligible for mitral interventions are scarce. This study aimed to assess characteristics and outcomes of severe MR patients treated medically following TMVR screening failure.METHODS: From 2016-2020, a total of 111 patients with severe MR underwent screening for TMVR. Screening failure occurred in 66 cases. Among these, 30 patients were treated with OMT only. Characteristics of these patients were analyzed, Kaplan-Meier estimates calculated, and univariate regression analysis performed. Median follow-up time was 2.26 years (95% confidence interval, 1.24-3.25).RESULTS: Anatomical reasons for screening failure in the study cohort (n = 30) were left ventricular (LV) restraints, risk of LV outflow tract obstruction, mitral annulus calcification, and sizing issues. Median ejection fraction was 56.0% (interquartile range, 38.8%-60.0%). Concomitant tricuspid regurgitation and severe pulmonary hypertension were present in 36.7% and 46.2%, respectively. Intercommissural diameters ranged from 22.5-52.0 mm. Mortality was 23.6% after 6 months and 35.7% after 1 year. Factors associated with mortality were female sex, MR severity, ischemic MR, high N-terminal pro-brain natriuretic peptide levels, and small annulus diameters.CONCLUSIONS: Despite growing experience with TMVR, the subset of MR patients anatomically eligible for TMVR is small and many patients are treated medically. Mortality in these patients remains high, underlining an unmet need for adequate therapeutic alternatives. TMVR devices adapting to broader annular size ranges with smaller ventricular profiles might fill this gap.",
author = "Sebastian Ludwig and Benedikt Koell and Roya Sedighian and Jessica Weimann and Niklas Schofer and Andreas Sch{\"a}fer and Lisa Voigtl{\"a}nder and Lara Waldschmidt and Johannes Schirmer and Moritz Seiffert and Simon Pecha and Dirk Westermann and Hermann Reichenspurner and Stefan Blankenberg and Edith Lubos and Lenard Conradi and Daniel Kalbacher",
year = "2021",
month = apr,
language = "English",
volume = "33",
pages = "E294--E301",
journal = "J INVASIVE CARDIOL",
issn = "1042-3931",
publisher = "HMP Communications",
number = "4",

}

RIS

TY - JOUR

T1 - Characteristics and Outcomes of Patients Ineligible for Transcatheter Mitral Valve Replacement (TMVR): Implications for Future Device Innovation

AU - Ludwig, Sebastian

AU - Koell, Benedikt

AU - Sedighian, Roya

AU - Weimann, Jessica

AU - Schofer, Niklas

AU - Schäfer, Andreas

AU - Voigtländer, Lisa

AU - Waldschmidt, Lara

AU - Schirmer, Johannes

AU - Seiffert, Moritz

AU - Pecha, Simon

AU - Westermann, Dirk

AU - Reichenspurner, Hermann

AU - Blankenberg, Stefan

AU - Lubos, Edith

AU - Conradi, Lenard

AU - Kalbacher, Daniel

PY - 2021/4

Y1 - 2021/4

N2 - OBJECTIVES: Due to high rates of transcatheter mitral valve replacement (TMVR) screening failure, a substantial proportion of patients with severe mitral regurgitation (MR) remains on optimal medical treatment (OMT) only. Data on outcomes of these patients ineligible for mitral interventions are scarce. This study aimed to assess characteristics and outcomes of severe MR patients treated medically following TMVR screening failure.METHODS: From 2016-2020, a total of 111 patients with severe MR underwent screening for TMVR. Screening failure occurred in 66 cases. Among these, 30 patients were treated with OMT only. Characteristics of these patients were analyzed, Kaplan-Meier estimates calculated, and univariate regression analysis performed. Median follow-up time was 2.26 years (95% confidence interval, 1.24-3.25).RESULTS: Anatomical reasons for screening failure in the study cohort (n = 30) were left ventricular (LV) restraints, risk of LV outflow tract obstruction, mitral annulus calcification, and sizing issues. Median ejection fraction was 56.0% (interquartile range, 38.8%-60.0%). Concomitant tricuspid regurgitation and severe pulmonary hypertension were present in 36.7% and 46.2%, respectively. Intercommissural diameters ranged from 22.5-52.0 mm. Mortality was 23.6% after 6 months and 35.7% after 1 year. Factors associated with mortality were female sex, MR severity, ischemic MR, high N-terminal pro-brain natriuretic peptide levels, and small annulus diameters.CONCLUSIONS: Despite growing experience with TMVR, the subset of MR patients anatomically eligible for TMVR is small and many patients are treated medically. Mortality in these patients remains high, underlining an unmet need for adequate therapeutic alternatives. TMVR devices adapting to broader annular size ranges with smaller ventricular profiles might fill this gap.

AB - OBJECTIVES: Due to high rates of transcatheter mitral valve replacement (TMVR) screening failure, a substantial proportion of patients with severe mitral regurgitation (MR) remains on optimal medical treatment (OMT) only. Data on outcomes of these patients ineligible for mitral interventions are scarce. This study aimed to assess characteristics and outcomes of severe MR patients treated medically following TMVR screening failure.METHODS: From 2016-2020, a total of 111 patients with severe MR underwent screening for TMVR. Screening failure occurred in 66 cases. Among these, 30 patients were treated with OMT only. Characteristics of these patients were analyzed, Kaplan-Meier estimates calculated, and univariate regression analysis performed. Median follow-up time was 2.26 years (95% confidence interval, 1.24-3.25).RESULTS: Anatomical reasons for screening failure in the study cohort (n = 30) were left ventricular (LV) restraints, risk of LV outflow tract obstruction, mitral annulus calcification, and sizing issues. Median ejection fraction was 56.0% (interquartile range, 38.8%-60.0%). Concomitant tricuspid regurgitation and severe pulmonary hypertension were present in 36.7% and 46.2%, respectively. Intercommissural diameters ranged from 22.5-52.0 mm. Mortality was 23.6% after 6 months and 35.7% after 1 year. Factors associated with mortality were female sex, MR severity, ischemic MR, high N-terminal pro-brain natriuretic peptide levels, and small annulus diameters.CONCLUSIONS: Despite growing experience with TMVR, the subset of MR patients anatomically eligible for TMVR is small and many patients are treated medically. Mortality in these patients remains high, underlining an unmet need for adequate therapeutic alternatives. TMVR devices adapting to broader annular size ranges with smaller ventricular profiles might fill this gap.

M3 - SCORING: Journal article

C2 - 33600355

VL - 33

SP - E294-E301

JO - J INVASIVE CARDIOL

JF - J INVASIVE CARDIOL

SN - 1042-3931

IS - 4

ER -