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Page 8 of 20 Nappi et al. Vessel Plus 2021;5:40 https://dx.doi.org/10.20517/2574-1209.2021.06

Table 2. Operative outcomes in transcatheter approach group [1,15,23-26,31]

Major All causes
Operative Procedural Reintervention Conversion to LVOT Stroke
Overall bleeding mortaluty at 30
mortality (%) success (%) (%) surgery (%) obstruction (%)
(%) days
US Registry 349

Brigham and Women’s Hospital 520 37 (7.1) 297.4 (57.2) 21 4 (0.7)
TMVR Registry 248 3 (1.2) 212 (85.5) 24 (5.6) 25 (10.1) 5 (2.0) 8 (3.2) 4 (1.6) 16 (6.5)
Mayo Clinic, NY University Medical Centre, 87 5 (5) 78 (90) 9 (10) 5 (6) 8 (9) 5 (6)
Intermounitain Heart Institute, University of Alabama, St.
Michael’s Hospital, Centre Cardiologique du Nord
Multicentre Published reports (2009-2018) 245 14 (5.7) 229 (93.5) 15 (6.1) 4 (1.6) 4 (1.6) 17 (8.1)

Flinders Medical Centre (Adelaide) (2017-2018) 7 1 (14) 6 (86) 1 (14) 1 (14) 0
St. Paul’s Hospital (Vancouver, Canada) 23 0 100 6 (26.1) 1 (4.4) 0 1 (4.4) 2 (9.6)

LVOT: Left ventricular outflow tract; TMVR: transcatheter mitral valve replacement.

calcium deposits in the valvular annulus. The use of CT imaging is useful in guiding the choice of device size in order to oversize by about 5%-10% of the
annulus area. In patients with oversizing superior to that 5%-10% range, a minimum neo-LVOT area of 250 mm and calcification expanding for more than
2
270° (75%), complications such as valve embolization and LVOT obstruction can be anticipated [14-16,19] [Table 2].

It is important to note that a potential benchmark for the use of TMVT was provided by a Harvard study . From 1992 to 2015, at Brigham and Women’s
[1]
Hospital, the authors reported 520 potential candidates for TMViV therapy in whom a failure of previous mitral valve replacement or repair surgery occurred.
They had a mean age of 64 ± 12 years and a median left ventricular ejection fraction of 60%. Median STS score was 6.12% ± 6.5%. In total, 319 patients had
NYHA Class III or IV. Of all patients, 273 had pMVR and 247 had pMVr. There were no differences in term of risk for permanent stroke between the two

groups (5.1% in pMVR and 5.3% in pMVr) or necessity of a surgical approach (0.7% in pMVR and 0.8% in pMVr), but there was a higher risk of major
bleeding in the pMVr group (5.3%) than in the pMVR group (2.9%). Operative mortality was higher in the pMVr group (9.3%) than in the pMVR group
(5.1%).

Recently, this topic has been extensively investigated in the cardiovascular literature. Two recent studies showed different results regarding post-procedural
residual mitral stenosis (MS) or residual mitral regurgitation (MR) and analyzed how transcatheter mitral valve replacement (TMVR) can be a valid approach
to patients with prosthetic degeneration (TMViV) or ring degeneration (TMViR) or in patients with mitral annulus calcification (TMV-in-MAC) [38-40] .