Mitral regurgitation severity predicts one-year therapeutic benefit of Tendyne transcatheter mitral valve implantation

Aims: Longitudinal outcomes of transcatheter therapies for secondary mitral regurgitation (MR) have been variable. This study examined predictors of one-year outcome following transcatheter mitral valve implantation (TMVI) with the Tendyne device. Methods and results: The first 100 consecutive patients with moderate-severe or severe MR enrolled in the Tendyne CE Mark trial were examined. Multivariable analyses assessed the impact of preoperative clinical and echocardiographic characteristics on one-year freedom from death or heart failure hospitalisation (HFH). All 100 patients underwent Tendyne TMVI without operative mortality. Univariate analysis was performed on implanted subjects, followed by multivariate analysis in those with complete predictive variable data. Patient characteristics: 76.5% male, 60.8% NYHA Class III/IV, age 75.6 +/- 7.5 years and Society of Thoracic Surgeons predicted risk of mortality of 8.5 +/- 6.1%. Increased left ventricular end-diastolic dimension was associated with one-year Tendyne benefit following univariate analysis (OR 0.35, p=0.010). Following multivariable adjustment, only severe MR, defined as a composite of effective regurgitant orifice area >= 0.3 cm(2) or regurgitant volume >= 45 ml, was associated with freedom from death or HFH at one year (OR 0.16, p = 0.032). Conclusions: Preoperative severe MR was predictive of improved one-year outcome following Tendyne TMVI. These results may inform therapy selection for the management of secondary MR and left ventricular dilatation.