BACKGROUND:Long-term outcomes of transcatheter mitral valve replacement (TMVR) with balloon-expandable aortic prostheses remain uncertain. OBJECTIVES:The aim of this study was to evaluate long-term clinical and hemodynamic outcomes after TMVR. METHODS:All patients undergoing TMVR at the authors' center were included. Balloon-expandable transcatheter heart valves were implanted in all cases, usually using a trans-septal approach. The primary outcome was a composite of death or mitral reintervention (surgical or transcatheter replacement or transplantation). Secondary outcomes included mortality, hemodynamic changes, recurrent mitral regurgitation, structural valve deterioration (SVD), and TMVR failure. RESULTS:A total of 200 patients underwent TMVR: 60.5% (121 of 200) valve-in-valve, 22.5% (45 of 200) valve-in-ring, and 17% (34 of 200) valve-in-mitral annular calcification. The median age was 70 years (Q1-Q3: 52-80 years), and 67% were women (134 of 200). Median follow-up was 3.2 years (Q1-Q3: 1.2-6.8 years). Freedom from death or reintervention at 1, 5, and 8 years was 82% (95% CI: 77%-88%), 48% (95% CI: 40%-56%), and 20% (95% CI: 11%-29%), respectively, with worse outcomes in valve-in-ring and valve-in-mitral annular calcification compared with valve-in-valve (P < 0.01). Mean gradient increased slightly over time (+0.25 ± 0.07 mm Hg/y; P < 0.01), with a modest decrease in effective orifice area (-0.04 cm2/y; P < 0.01). Significant recurrent mitral regurgitation occurred in 5.5% of patients (11 of 200). Seven percent (14 of 200) developed severe SVD after 5.3 (Q1-Q3: 3.5-7.4 years), and 10% (20 of 200) developed TMVR failure after 4.4 (Q1-Q3: 1.8-6.7 years). CONCLUSIONS:TMVR with balloon-expandable aortic prostheses provides favorable long-term outcomes and acceptable durability, with low rates of severe SVD and valve failure.

BACKGROUND:The impact of right ventricular dysfunction on transcatheter mitral valve implantation outcomes and the evolution of right ventricular function after the procedure has not been described. AIMS:To analyse the impact of right ventricular dysfunction on immediate and mid-term outcomes of transcatheter mitral valve implantation, and the evolution of right ventricular function in these patients. METHODS:Consecutive patients who underwent transcatheter mitral valve implantation in our institution were included. Right ventricular function was assessed before transcatheter mitral valve implantation by transthoracic echocardiography, using a multivariable approach. Patients were divided into two groups according to the preprocedural presence of right ventricular dysfunction. Patients were followed up at 3 months and 1 year with a new echocardiographic assessment at each time point. RESULTS:Among 109 patients finally included (mean age 65±19 years; 66% women), 77 (71%) had normal right ventricular function and 32 (29%) had right ventricular dysfunction before transcatheter mitral valve implantation. Technical success was achieved in 92 (84%) patients. At 30 days, there were no differences between the group with normal right ventricular function and the group with right ventricular dysfunction in terms of death (5 vs. 6%; P=0.86), all-cause rehospitalization (20 vs. 31%; P=0.17) and heart failure without hospitalization (13 vs. 6%; P=0.5). Although the 1-year survival rate was higher in the group with normal right ventricular function (83.1%, 95% confidence interval 74.3% to 92.9%) than in the group with right ventricular dysfunction (68.2%, 95% confidence interval 52.9% to 88.1%) (P=0.09), these differences were not significant after adjustment. Transcatheter mitral valve implantation was associated with improved right ventricular function in the group with initial right ventricular dysfunction at 1-year follow-up (P<0.01). CONCLUSIONS:Right ventricular dysfunction does not appear to have an impact on the early outcomes of transcatheter mitral valve implantation. However, it was associated with an increased rate of late death, although differences were not statistically significant after adjustment. Successful transcatheter mitral valve implantation in patients with severe mitral valve disease associated with right ventricular dysfunction leads to significant improvement in right ventricular function.

BACKGROUND:Medium- and long-term outcomes after transcatheter paravalvular leak (PVL) closure remain poorly documented, with limited prospective data on predictors of morbidity and mortality. AIMS:This study aimed to assess medium-term outcomes and identify key predictive factors of mortality or surgical reintervention at 2 years after transcatheter PVL closure. METHODS:The prospective Fermeture de Fuite ParaProthétique (FFPP) Registry included consecutive symptomatic patients undergoing transcatheter PVL closure across 24 European centres between 2017 and 2019. Predictive factors for mortality and surgical reintervention were analysed over a 2-year follow-up. RESULTS:A total of 213 symptomatic patients underwent 237 procedures. The mean age was 68±11 years, with a median European System for Cardiac Operative Risk Evaluation (EuroSCORE) II of 6 (interquartile range [IQR] 4-10). PVL involved the mitral valve in 64.6% of cases and mechanical prostheses in 53.3%. Heart failure and haemolytic anaemia were present in 89.5% and 49.8% of patients, respectively. The transapical approach was used in 6.8% of cases. Technical success was achieved in 87.3% of procedures, and clinical success at 1 month was achieved in 70.5% of patients. The median follow-up was 24.4 months (IQR 23.2-26.4). The survival rate at 2 years without the need for surgical reintervention was 66.1% (95% confidence interval [CI]: 60.1-72.7). Multivariate analysis identified mitral PVL, mechanical valves, and haemolytic anaemia as independent risk factors for adverse outcomes during follow-up. The absence of clinical success at 1 month was the strongest predictor of adverse outcomes (hazard ratio 5.00, 95% CI: 2.70-9.09; p=0.001). CONCLUSIONS:Transcatheter PVL closure offers a durable therapeutic option for high-risk patients when early clinical success is achieved. Mitral valve involvement, mechanical prostheses, and haemolytic anaemia remain key predictors of poor outcomes over a 2-year follow-up.

Background: In patients with significant tricuspid regurgitation, cardiac magnetic resonance imaging (CMR) is the preferred method for the evaluation of right ventricular function and volumes. However validated thresholds are lacking. Aim: The aim of this study was to evaluate CMR assessment of right ventricular volumes in patients with significant (moderate or severe) tricuspid regurgitation, and to define its association with outcomes. Methods: The PRONOVAL study is a retrospective multicentre study using the clinical data warehouse of Greater Paris University Hospitals (AP-HP). Patients were screened for CMR in the PMSI (Programme de m & eacute;dicalisation des syst & egrave;mes d'information). Hospitalization reports were analysed by natural language processing to include patients with tricuspid regurgitation. Exclusion criteria were left heart valvular disease, heart transplantation and cardiac amyloidosis. Primary outcome was a combined criterion of death or tricuspid surgery. Results: Between September 2017 and September 2021, 151 patients with isolated tricuspid regurgitation were screened. Right ventricular function and volumes were available in 86 (57.0%) CMR reports (the complete CMR group). In the complete CMR group, tricuspid regurgitation was severe in 62 patients (72.1%). Median age was 67.0 years (interquartile range 58.0-75.8). Median right ventricular indexed end-diastolic volume was 98.0 mL/m(2) (interquartile range 66.8-118.5). At 2-year follow-up, six patients (9.2%) had undergone tricuspid valve surgery, and 12 patients (18.5%) had died. Right ventricular indexed end-diastolic volume was associated with death or surgery at 2years, with an area under the receiver operating characteristic curve of 0.76 (95% confidence interval 0.75-0.77) for a threshold of 119mL/m(2). Conclusion: Right ventricular indexed end-diastolic volume >119mL/m(2) was found to be an independent indicator of death or surgery in patients with significant tricuspid regurgitation. (c) 2024 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Secondary mitral regurgitation (MR) associated with left ventricular dysfunction carries a high risk of acute heart failure during pregnancy because of associated hemodynamic changes. Mitral transcatheter edge-to-edge repair (TEER) is currently recommended for symptomatic patients with secondary MR; however, no evidence exists on the use of this therapy in pregnancy. We present a case of secondary MR in a pregnant woman with dilated cardiomyopathy. She was successfully treated with TEER with minimal use of fluoroscopy (35 seconds). This is the first case to our knowledge of mitral TEER during pregnancy described in the literature, suggesting feasibility and safety of this procedure.

Transcatheter edge-to-edge repair (TEER) is an alternative for patients with severe degenerative mitral regurgitation (MR). The objective of this study was to compare the outcomes of surgery and TEER in older patients with degenerative MR patients using real life data. Consecutives older patients (≥ 65 years-old), with severe symptomatic, degenerative MR requiring surgery or TEER between 2013 and 2023 were included. Exclusion criteria were secondary MR, and active endocarditis. Primary outcome was a composite of all-cause death, hospitalization for heart failure or mitral valve intervention within one year. A total of 295 patients were included (203 underwent surgery and 92 underwent TEER). At 1 year, 26 (9

Importance Managing isolated severe tricuspid regurgitation (TR) poses significant challenges, with questions recently arising about the efficacy of surgery and percutaneous therapies compared with conservative approaches in improving survival.Objective We aimed to assess the available evidence on mortality associated with different treatment modalities for isolated severe TR.Evidence review A comprehensive search of medical databases was conducted. Studies reporting mortality of isolated TR at 1-year follow-up, with TR severity classified as moderate-to-severe or worse, were included. Exclusion criteria were TR associated with left-heart disease and combined procedures (treating other valves). The primary endpoint was all-cause mortality at 1 year, with secondary outcomes including in-hospital, 2-year and 5-year mortality. Mortality was compared by meta-analysis and meta-regression using age, sex and left ventricular ejection fraction as confounders.Findings 25 studies met the inclusion criteria. Mean age was 72.0 years among the 5702 patients managed medically, 71.3 years among the 1416 patients treated percutaneously and 59.3 years among the 1990 patients managed surgically. In medically managed patients, 1-year, 2-year and 5-year mortality rates were 14%, 20% and 46%, respectively. Among percutaneously managed patients, there was an in-hospital mortality of 1% and a 1-year mortality rate of 18%, which increased to 22% at 2 years. Surgically managed patients experienced an in-hospital mortality of 8% with 1-year, 2-year and 5-year mortality rates of 15%, 20% and 30%, respectively. No statistical differences in mortality were observed at 1, 2 or 5 years. Those results were confirmed after adjusted meta-regression.Conclusions These findings underscore the significant long-term mortality associated with isolated severe TR, regardless of treatment group. Despite potential selection bias, both percutaneous and surgical interventions did not offer lower mortality rates compared with medical management after 2 years. Further research is warranted to improve outcomes in the management of isolated TR.

BACKGROUND:There is currently no established recommendation for antithrombotic treatment following transcatheter mitral valve replacement (TMVR). However, based on the analogy with surgical mitral bioprosthesis, vitamin K antagonists (VKAs) are predominantly used. OBJECTIVES:The purpose of this study was to compare bleeding and thrombotic events associated with direct oral anticoagulants (DOACs) or VKAs in a prospective cohort of TMVR patients. METHODS:We enrolled consecutive patients who underwent transseptal TMVR using a SAPIEN family prosthesis at our center between 2011 and 2023. The primary outcome was the occurrence of bleeding. VKAs were administered to patients until October 2019, after which DOACs were prescribed. The median follow-up was 4.7 months (Q1-Q3: 2.6-6.7 months). RESULTS:A total of 156 patients were included. The mean age was 65 ± 18.5 years, and 103 patients (66%) were women. The median EuroSCORE II was 7.48% (Q1-Q3: 3.80%-12.97%). Of the participants, 20.5% received DOACs and 79.5% were treated with VKAs. The primary outcome was observed in 50 (40%) patients in the VKA group and 3 (9%) patients in the DOAC group (adjusted HR: 0.21; 95% CI: 0.06-0.74; P = 0.02). Treatment with DOAC was associated with a shorter length of hospital stay. No significant differences were found in terms of thrombotic events, major vascular complications, stroke, or death. CONCLUSIONS:The use of DOACs after TMVR, compared with VKAs, appears to reduce the risk of bleeding complications and decrease the length of hospital stay for patients, without a significant increase in the risk of thrombotic events.

The relationship between left ventricular (LV) remodeling and clinical outcomes after treatment of severe mitral regurgitation (MR) in heart failure (HF) has not been examined.The aim of this study was to evaluate the association between LV reverse remodeling and subsequent outcomes and assess whether transcatheter edge-to-edge repair (TEER) and residual MR are associated with LV remodeling in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial.Patients with HF and severe MR who remained symptomatic on guideline-directed medical therapy (GDMT) were randomized to TEER plus GDMT or GDMT alone. Baseline and 6-month core laboratory measurements of LV end-diastolic volume index and LV end-systolic volume index were examined. Change in LV volumes from baseline to 6 months and clinical outcomes from 6 months to 2 years were evaluated using multivariable regression.The analytical cohort comprised 348 patients (190 treated with TEER, 158 treated with GDMT alone). A decrease in LV end-diastolic volume index at 6 months was associated with reduced cardiovascular death between 6 months and 2 years (adjusted HR: 0.90 per 10 mL/m2 decrease; 95% CI: 0.81-1.00; P = 0.04), with consistent results in both treatment groups (Pinteraction = 0.26). Directionally similar but nonsignificant relationships were present for all-cause death and HF hospitalization and between reduced LV end-systolic volume index and all outcomes. Neither treatment group nor MR severity at 30 days was associated with LV remodeling at 6 or 12 months. The treatment benefits of TEER were not significant regardless of the degree of LV remodeling at 6 months.In patients with HF and severe MR, LV reverse remodeling at 6 months was associated with subsequently improved 2-year outcomes but was not affected by TEER or the extent of residual MR. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial] and COAPT CAS [COAPT]; NCT01626079)

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Transcatheter mitral valve implantation (TMVI) has emerged as an alternative to surgery in high risk patients with failing mitral bioprosthesis (valve-in-valve) or annuloplasties (valve-in-ring). The presence of an elevated mean gradient > 5mmHg after the procedure has been defined as an unsuccessful procedure but the impact and outcomes of an elevated mean gradient after TMVI have not been studied. Materials and methods 103 patients undergoing TMVI from 2010 to 2020 were included. Patients were classified in three groups according to mean gradient after the procedure: Group 1< 5mmHg, Group 2 between 5 and 10mmHg and Group 3 > 10mmHg. Results The median age was 71 (52.5–81.5) years. Indications for TMVI were bioprosthesis failure in 67 patients (65%) and ring annuloplasty failure in 36 patients (35%). 84 (81.6%) patients were in NYHA class III or IV. 42 patients were in group 1, 51 in group 2 and 10 in group 3, without any difference in baseline characteristics or procedural findings. At 30 days, the rates of all-cause mortality (respectively 2,6%, 0% and 0%, p = 0,66), rehospitalization for heart failure (respectively 8,4%, 7,7% and 8,4%, p = 0,89), paravalvular leak (10,3%, 27,7%, 22,2%, p = 0,33), LVOT obstruction (respectively 6,3%, 8,2% and 10%, p = 0,99) or valve thrombosis (respectively 7,7%, 4,3% and 0%) were similar in the three groups. At a median follow up of 2 years, 27 patients have died with a cumulative rate of all-cause mortality at 1 and 2 years of 21.5% and 38.1% respectively. The presence of an elevated mean gradient was not associated with increased risk of mortality (HR=1,11, (95% CI [0,93, 1,31]), p = 0,25) An improvement of NYHA class was observed in the three groups without any difference between the groups. Median systolic pulmonary arterial pressure significantly improved in group 1 (from 53mmHg (30–90) in baseline to 45mmHg (25–60), p = 0.005) and 2 (from 55mmHg (30–112) in baseline to 40mmHg (30–75), p = 0.004)) but not in group 3. Conclusion An elevated mean gradient post-TMVI had no impact on cardiovascular outcomes up to 2 years. Further studies with longer follow up are necessary.

AIMS:The impact of sexuality in patients with significant tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve intervention (TTVI) is unknown. The aim of this study was to investigate sex-specific outcomes in patients with significant TR treated with TTVI vs. medical therapy alone.METHODS AND RESULTS:The Transcatheter Tricuspid Valve Therapies (TriValve) registry collected data on patients with significant TR from 24 centres who underwent TTVI from 2016 to 2021. A control cohort was formed by medically managed patients with ≥severe isolated TR diagnosed in 2015-18. The primary endpoint was freedom from all-cause mortality. Secondary endpoints were heart failure (HF) hospitalization, New York Heart Association (NYHA) functional status, and TR severity. One-year outcomes were assessed for the TriValve cohort and compared with the control cohort with the inverse probability of treatment weighting (IPTW). A total of 556 and 2072 patients were included from the TriValve and control groups, respectively. After TTVI, there was no difference between women and men in 1-year freedom from all-cause mortality 80.9% vs. 77.9%, P = 0.56, nor in HF hospitalization (P = 0.36), NYHA Functional Classes III and IV (P = 0.17), and TR severity >2+ at last follow-up (P = 0.42). Multivariable Cox-regression weighted by IPTW showed improved 1-year survival after TTVI compared with medical therapy alone in both women (adjusted hazard ratio 0.45, 95% confidence interval 0.23-0.83, P = 0.01) and men (adjusted hazard ratio 0.42, 95% confidence interval 0.18-0.89, P = 0.03).CONCLUSION:After TTVI in high-risk patients, there were no sex-related differences in terms of survival, HF hospitalization, functional status, and TR reduction up to 1 year. The IPTW analysis shows a survival benefit of TTVI over medical therapy alone in both women and men.

BACKGROUND:Data regarding the impact of the tricuspid valve gradient (TVG) after tricuspid transcatheter edge-to-edge repair (TEER) are scarce. OBJECTIVES:This study sought to evaluate the association between the mean TVG and clinical outcomes among patients who underwent tricuspid TEER for significant tricuspid regurgitation. METHODS:Patients with significant tricuspid regurgitation who underwent tricuspid TEER within the TriValve (International Multisite Transcatheter Tricuspid Valve Therapies) registry were divided into quartiles based on the mean TVG at discharge. The primary endpoint was the composite of all-cause mortality and heart failure hospitalization. Outcomes were assessed up to the 1-year follow-up. RESULTS:A total of 308 patients were included from 24 centers. Patients were divided into quartiles of the mean TVG as follows: quartile 1 (n = 77), 0.9 ± 0.3 mm Hg; quartile 2 (n = 115), 1.8 ± 0.3 mm Hg; quartile 3 (n = 65), 2.8 ± 0.3 mm Hg; and quartile 4 (n = 51), 4.7 ± 2.0 mm Hg. The baseline TVG and the number of implanted clips were associated with a higher post-TEER TVG. There was no significant difference across TVG quartiles in the 1-year composite endpoint (quartiles 1-4: 35%, 30%, 40%, and 34%, respectively; P = 0.60) or the proportion of patients in New York Heart Association class III to IV at the last follow-up (P = 0.63). The results were similar after adjustment for clinical and echocardiographic characteristics (composite endpoint quartile 4 vs quartile 1-quartile 3 adjusted HR: 1.05; 95% CI: 0.52-2.12; P = 0.88) or exploring post-TEER TVG as a continuous variable. CONCLUSIONS:In this retrospective analysis of the TriValve registry, an increased discharge TVG was not significantly associated with adverse outcomes after tricuspid TEER. These findings apply for the explored TVG range and up to the 1-year follow-up. Further investigations on higher gradients and longer follow-up are needed to better guide the intraprocedural decision-making process.

The assessment of mitral bioprosthetic area remains a technical challenge, and its calculation by the continuity equation using transthoracic echocardiography (TTE) may be invalidated in several situations, especially after transcatheter mitral valve implantation (TMVI). This study aims to develop a new technique to measure the mitral valve area after a TMVI using a multimodal three-dimensional echocardiographic and computed tomography (CT) approach. Among the patients hospitalized for TMVI at Bichat Hospital between June 2017 and February 2021, we selected 24 who had both a transesophageal echocardiography (TEE) and a cardiac CT after TMVI and before discharge. We performed two area measurements by planimetry: the geometric orifice area (GOA) corresponding to the area delimited by the edges of the open valve leaflets after alignment in the plane of the proximal coaptation point of the bioprosthesis leaflets; and the smallest valve area (SVA) defined by the smallest measurable area of the open prosthesis, at the free edges of the leaflets. In our cohort, the GOA was 1.73 ± 0.41 cm2 on 3D TEE and 1.75 ± 0.42 cm2 on CT. The SVA was 1.40 ± 0.31 cm2 on 3D TEE and 1.49 ± 0.37 cm2 on CT. There was a good agreement between the two techniques for GOA and SVA (ICC > 0.6, P < 0.01) and a good correlation between the two measurements on 3D TEE as well as on CT (Pearson 0.88 and 0.91 respectively, P < 0.001). Our work suggests a new approach to multimodal assessment of prosthetic mitral valve area after TMVI, using 3D TEE and CT scan. Further studies are needed to complete our results, especially to confirm the feasibility and reproducibility of the measurements. It would also be interesting to correlate these area measurements with the clinical prognosis of patients after TMVI. Agreement between 3D TEE and CT measurements (Fig. 1).

The incidence and prognostic impact of bleeding complications after transcatheter mitral valve implantation (TMVI) are unknown. To report the incidence, predictors and long-term prognostic impact of early major bleeding (EMB) complications in patients undergoing TMVI. All patients consecutively treated with TMVI using a transseptal approach in our center were included. After TMVI, patients were treated with an anticoagulant therapy for the first 3 months combined with an antiplatelet therapy in the absence of a prohibitive bleeding risk. A predefined follow-up was planned at discharge, 3 months, 1 year and yearly thereafter. EMB was defined as a bleeding complication of at least major severity according to the modified mitral valve academic research consortium bleeding scale and occurring within the first 3 months. Predictors of EMBs and their association with the 1-year rate of death or rehospitalization for heart failure were assessed. Among 157 patients who underwent TMVI between July 2010 and March 2022, an EMB occurred in 25 (15.9%) at a median time of 4 days (interquartile range: 0 to 8 days) after the procedure. Life-threatening or fatal bleeding occured in 9 (5.7%) patients. EMBs were mainly periprocedural (n = 22 [88%]) and the most frequent localization was vascular (n = 18 [66.7%]). Predictors of EMB were severe chronic renal failure (P = 0.008) and male sex (P = 0.04). EMBs were identified as an independent predictor of death or rehospitalization for heart failure at 1-year (adjusted hazard ratio: 2.26; 95% confidence interval: 1.10–4.63; P = 0.026) (Fig. 1). EMBs after TMVI is frequent and associated with an increased risk of death or rehospitalization for heart failure. Larger studies are needed to improve the management of antithrombotic therapy in this high-risk bleeding population.

BACKGROUND:Transcatheter aortic valve implantation now has a major role in the treatment of patients with severe aortic stenosis. However, evidence is scarce on its feasibility and safety to treat patients with pure aortic regurgitation. AIMS:We sought to evaluate the results of transcatheter aortic valve implantation using the balloon-expandable SAPIEN 3 transcatheter heart valve (Edwards Lifesciences, Irvine, CA, USA) in patients with pure aortic regurgitation on native non-calcified valves. METHODS:We conducted a retrospective and prospective French multicentre observational study. We included all patients with symptomatic severe pure aortic regurgitation on native non-calcified valves, contraindicated to or at high risk for surgical valve replacement, who underwent transcatheter aortic valve implantation using the SAPIEN 3 transcatheter heart valve. RESULTS:A total of 37 patients (male sex, 73%) with a median age of 81years (interquartile range 69-85years) were screened using transthoracic echocardiography and computed tomography and were included at eight French centres. At baseline, 83.8% of patients (n=31) had dyspnoea New York Heart Association class≥III. The device success rate was 94.6% (n=35). At 30days, the all-cause mortality rate was 8.1% (n=3) and valve migration occurred in 10.8% of cases (n=4). Dyspnoea New York Heart Association class≤II was seen in 86.5% of patients (n=32), and all survivors had aortic regurgitation grade≤1. At 1-year follow-up, all-cause mortality was 16.2% (n=6), 89.7% (n=26/29) of survivors were in New York Heart Association class≤II and all had aortic regurgitation grade≤2. CONCLUSION:Transcatheter aortic valve implantation using the SAPIEN 3 transcatheter heart valve seems promising to treat selected high-risk patients with pure aortic regurgitation on non-calcified native valves, contraindicated to surgical aortic valve replacement.

BACKGROUND:Transcatheter mitral valve implantation (TMVI) may be attractive to treat high-risk patients with mitral bioprosthesis or annuloplasty ring failure or severe mitral annular calcification. AIM:To report the outcomes of patients after valve-in-valve/ring/mitral annular calcification TMVI using balloon expandable transcatheter aortic valves, according to the degree of urgency of the procedure. METHODS:All patients who underwent TMVI in our centre from 2010 to 2021 were classified into three groups: elective, urgent or emergent/salvage TMVI. RESULTS:A total of 157 patients were included: 129 (82.2%) had elective, 21 (13.4%) urgent and 7 (4.4%) had emergent/salvage TMVI. Patients with emergent/salvage TMVI had a higher EuroSCORE II: elective, 7.3%; urgent, 9.7%; emergent/salvage, 54.5% (P<0.0001). The indication for TMVI was bioprosthesis failure in all of the emergent/salvage group, in 13 of the urgent group (61.9%) and in 62 of the elective group (48.1%). Overall, the technical success rate of TMVI was 86%, and was similar in the three groups (elective, 86.1%; urgent, 95.2%; emergent/salvage, 71.4%). The cumulative survival rate at 2-year follow-up was lower in the emergent/salvage group than in the elective or urgent group (42.9% vs 71.2% for the elective group; 76.2% for the urgent group; log-rank test, P=0.012). The excess mortality in the emergent/salvage group occurred during the first month postprocedure. Thereafter, the 30-day landmark analysis did not show any more statistical difference between the three groups (log-rank test, P=0.94). CONCLUSIONS:Emergent/salvage TMVI was associated with high early mortality, but 1-month survivors had similar outcomes to patients with elective/urgent TMVI. The degree of urgency of the procedure should not prevent TMVI in high-risk patients.

Transcatheter mitral valve implantation (TMVI) may be a therapeutic option in high-risk operative patients with failing bioprosthesis or annuloplasty, or severe mitral valve disease associated with mitral annulus calcification. The impact and evolution of right ventricular (RV) dysfunction in TMVI have not been described. The objective of this study was to analyse the impact of RV function (RVF) on the immediate and long-term prognosis of patients treated with TMVI and the evolution of RVF at one year after TMVI. Patients who underwent TMVI were retrospectively classified into 2 groups: absence or presence of RV dysfunction. RVF was assessed before TMVI, at 30 days, at 3–6 months, and at 1 year by transthoracic echocardiography using a multiparametric approach including measurements of TAPSE, S’TDI wave, RVFAC, and qualitative visual assessment by the sonographer. Among 109 patients (age 65 ± 19 years, 66% female) who underwent TMVI since 2010, 77 (71%) had normal RVF, 32 (29%) had RV dysfunction. Technical success was achieved in 92 patients (84%). At 30 days, there was no difference in mortality between the group with normal RVF and the group with RV dysfunction (5% vs. 6%, P = 0.86), in rehospitalization (20% vs. 31%, P = 0.17) or in heart failure without hospitalization (13% vs. 6%, P = 0.5). The median follow-up was 378 days. The one-year survival rate was 87.8% (95% CI [79.7%; 96.8%]) in the group with normal RVF versus 73.0% (95% CI [57.6%; 92.6%]) in the group with RV dysfunction (P = 0.06) (Fig. 1). In the group with initial RV dysfunction, patients significantly improved their RV function at one-year follow-up (P < 0.01). RV dysfunction does not seem to have an impact on the early clinical outcome after TMVI, but it is associated with an unfavourable prognosis with increased mortality at one year. Our study suggests that successful TMVI in patients with severe mitral valve disease associated with RV dysfunction leads to significant improvement of RV function.

HomeCirculation: Cardiovascular ImagingAhead of PrintFour-Dimensional Flow Magnetic Resonance Imaging Features of a Platypnea-Orthodeoxia Syndrome Caused by a Patent Foramen Ovale No AccessCase ReportRequest AccessAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialNo AccessCase ReportRequest AccessFour-Dimensional Flow Magnetic Resonance Imaging Features of a Platypnea-Orthodeoxia Syndrome Caused by a Patent Foramen Ovale Samuel Sitbon, Phalla Ou, Caroline Nguyen, Carsten Ehmer, Eric Garbarz, Eric Brochet, Adeline Fuchs, Pierre Aubry and Jeremie Abtan Samuel SitbonSamuel Sitbon https://orcid.org/0000-0003-0639-3557 Département de Cardiologie, Hôpital Bichat, AP-HP (Assistance Publique – Hôpitaux de Paris), Université de Paris, France (S.S., C.N., E.G., E.B., A.F., P.A., J.A.). , Phalla OuPhalla Ou Département de Radiologie, Hôpital Bichat, AP-HP (Assistance Publique – Hôpitaux de Paris), Université de Paris, France (P.O., C.E.). , Caroline NguyenCaroline Nguyen Département de Cardiologie, Hôpital Bichat, AP-HP (Assistance Publique – Hôpitaux de Paris), Université de Paris, France (S.S., C.N., E.G., E.B., A.F., P.A., J.A.). , Carsten EhmerCarsten Ehmer Département de Radiologie, Hôpital Bichat, AP-HP (Assistance Publique – Hôpitaux de Paris), Université de Paris, France (P.O., C.E.). , Eric GarbarzEric Garbarz Département de Cardiologie, Hôpital Bichat, AP-HP (Assistance Publique – Hôpitaux de Paris), Université de Paris, France (S.S., C.N., E.G., E.B., A.F., P.A., J.A.). , Eric BrochetEric Brochet Département de Cardiologie, Hôpital Bichat, AP-HP (Assistance Publique – Hôpitaux de Paris), Université de Paris, France (S.S., C.N., E.G., E.B., A.F., P.A., J.A.). , Adeline FuchsAdeline Fuchs Département de Cardiologie, Hôpital Bichat, AP-HP (Assistance Publique – Hôpitaux de Paris), Université de Paris, France (S.S., C.N., E.G., E.B., A.F., P.A., J.A.). , Pierre AubryPierre Aubry Département de Cardiologie, Hôpital Bichat, AP-HP (Assistance Publique – Hôpitaux de Paris), Université de Paris, France (S.S., C.N., E.G., E.B., A.F., P.A., J.A.). and Jeremie AbtanJeremie Abtan Correspondence to: Jeremie Abtan, MD, PhD, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris. Email E-mail Address: [email protected] https://orcid.org/0000-0001-8968-6624 Département de Cardiologie, Hôpital Bichat, AP-HP (Assistance Publique – Hôpitaux de Paris), Université de Paris, France (S.S., C.N., E.G., E.B., A.F., P.A., J.A.). FACT (French Alliance for Cardiovascular Clinical Trials), an F-CRIN network, Paris, France (J.A.). Originally published24 Apr 2023https://doi.org/10.1161/CIRCIMAGING.122.014722Circulation: Cardiovascular Imaging. 2023;0:e014722FootnotesSupplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCIMAGING.122.014722.Correspondence to: Jeremie Abtan, MD, PhD, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris. Email jeremie.[email protected]fr Previous Back to top Next FiguresReferencesRelatedDetails Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/CIRCIMAGING.122.014722PMID: 37092323 Originally publishedApril 24, 2023 Keywordsforamen ovale, patentplatypnea orthodeoxia syndromemagnetic resonance imagingPDF download Advertisement SubjectsDiagnostic TestingEchocardiography