Characteristics and Outcomes of Patients Screened for Transcatheter Mitral Valve Implantation: 1-Year Results from the CHOICE-MI Registry.

Ali, Walid Ben; Ludwig, Sebastian; Duncan, Alison; Weimann, Jessica; Nickenig, Georg; Tanaka, Tetsu; Coisne, Augustin; Vincentelli, Andre; Makkar, Raj; Webb, John G; Akodad, Mariama; Muller, David W M; Praz, Fabien; Wild, Mirjam G; Hausleiter, Jörg; Goel, Sachin S; von Ballmoos, Moritz Wyler; Denti, Paolo; Chehab, Omar; Redwood, Simon; ... (2022). Characteristics and Outcomes of Patients Screened for Transcatheter Mitral Valve Implantation: 1-Year Results from the CHOICE-MI Registry. European journal of heart failure, 24(5), pp. 887-898. Wiley 10.1002/ejhf.2492

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AIMS

Transcatheter mitral valve implantation (TMVI) represents a novel treatment option for patients with mitral regurgitation (MR) unsuitable for established therapies. The CHOICE-MI registry aimed to investigate outcomes of patients undergoing screening for TMVI.

METHODS AND RESULTS

From 05/2014 to 03/2021, patients with MR considered suboptimal candidates for transcatheter edge-to-edge repair (TEER) and at high risk for mitral valve surgery underwent TMVI screening at 26 centres. Characteristics and outcomes were investigated for patients undergoing TMVI and for TMVI-ineligible patients referred to bailout-TEER, high-risk surgery or medical therapy (MT). The primary composite endpoint was all-cause mortality or heart failure hospitalisation after 1 year. Among 746 patients included (78.5 years [IQR 72.0-83.0], EuroSCORE II 4.7% [IQR 2.7-9.7]), 229 patients (30.7%) underwent TMVI with ten different dedicated devices. At 1 year, residual MR ≤1+ was present in 95.2% and the primary endpoint occurred in 39.2% of patients treated with TMVI. In TMVI-ineligible patients (N = 517, 69.3%), rates of residual MR ≤1+ were 37.2%, 100.0% and 2.4% after bailout-TEER, high-risk surgery and MT, respectively. The primary endpoint at 1 year occurred in 28.8% of patients referred to bailout-TEER, in 42.9% of patients undergoing high-risk surgery and in 47.9% of patients remaining on MT.

CONCLUSION

This registry included the largest number of patients treated with TMVI to date. TMVI with ten dedicated devices resulted in predictable MR elimination and sustained functional improvement at 1 year. In TMVI-ineligible patients, bailout-TEER and high-risk surgery represented reasonable alternatives, while MT was associated with poor clinical and functional outcomes. This article is protected by copyright. All rights reserved.

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