Transapical Mitral Valve Replacement: 1-Year Results of the Real-World Tendyne European Experience Registry.

Hell, Michaela M; Wild, Mirjam G; Baldus, Stephan; Rudolph, Tanja; Treede, Hendrik; Petronio, Anna Sonia; Modine, Thomas; Andreas, Martin; Coisne, Augustin; Duncan, Alison; Franco, Luis Nombela; Praz, Fabien; Ruge, Hendrik; Conradi, Lenard; Zierer, Andreas; Anselmi, Amedeo; Dumonteil, Nicolas; Nickenig, Georg; Piñón, Miguel; Barth, Sebastian; ... (2024). Transapical Mitral Valve Replacement: 1-Year Results of the Real-World Tendyne European Experience Registry. JACC. Cardiovascular Interventions, 17(5), pp. 648-661. Elsevier 10.1016/j.jcin.2023.12.027

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BACKGROUND

Early studies of the Tendyne transcatheter mitral valve replacement (TMVR) showed promising results in a small selective cohort.

OBJECTIVES

The authors present 1-year data from the currently largest commercial, real-world cohort originating from the investigator-initiated TENDER (Tendyne European Experience) registry.

METHODS

All patients from the TENDER registry eligible for 1-year follow-up were included. The primary safety endpoint was 1-year cardiovascular mortality. Primary performance endpoint was reduction of mitral regurgitation (MR) up to 1 year.

RESULTS

Among 195 eligible patients undergoing TMVR (median age 77 years [Q1-Q3: 71-81 years], 60% men, median Society of Thoracic Surgeons Predicted Risk of Mortality 5.6% [Q1-Q3: 3.6%-8.9%], 81% in NYHA functional class III or IV, 94% with MR 3+/4+), 31% had "real-world" indications for TMVR (severe mitral annular calcification, prior mitral valve treatment, or others) outside of the instructions for use. The technical success rate was 95%. The cardiovascular mortality rate was 7% at 30 day and 17% at 1 year (all-cause mortality rates were 9% and 29%, respectively). Reintervention or surgery following discharge was 4%, while rates of heart failure hospitalization reduced from 68% in the preceding year to 25% during 1-year follow-up. Durable MR reduction to ≤1+ was achieved in 98% of patients, and at 1 year, 83% were in NYHA functional class I or II. There was no difference in survival and major adverse events between on-label use and "real-world" indications up to 1 year.

CONCLUSIONS

This large, real-world, observational registry reports high technical success, durable and complete MR elimination, significant clinical benefits, and a 1-year cardiovascular mortality rate of 17% after Tendyne TMVR. Outcomes were comparable between on-label use and "real-world" indications, offering a safe and efficacious treatment option for patients without alternative treatments. (Tendyne European Experience Registry [TENDER]; NCT04898335).

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