Clinical Outcomes of Transfemoral Transcatheter Mitral Valve Replacement: Results From the CHOICE-MI Registry.

DOI
Publisher DOI
PubMed ID
42575577
Abstract
BACKGROUND: Transcatheter mitral valve replacement (TMVR) is an alternative for patients with mitral regurgitation (MR), but data on transfemoral (TF) devices are limited.

OBJECTIVES: The aim of this study was to evaluate clinical, echocardiographic, and functional outcomes following TF TMVR in an international registry.

METHODS: The CHOICE-MI (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency) Registry included patients undergoing TMVR with dedicated devices at 41 international centers. This analysis included only TF TMVR. Outcomes were assessed per Mitral Valve Academic Research Consortium criteria. Echocardiographic, functional, and clinical outcomes up to 2 years were reported. The primary endpoint was a composite of all-cause mortality or heart failure hospitalization at 2 years. Predictors were identified using multivariable Cox regression.

RESULTS: A total of 124 patients (median age 79 years [Q1-Q3: 75-83 years], 50% women, median European System for Cardiac Operative Risk Evaluation II score 5.0% [Q1-Q3: 3.3-8.5]) underwent TF TMVR with 9 different devices. The leading MR etiology was primary MR (n = 49 [39.5%]), with mitral annular calcification in 12.9%. Technical success was achieved in 113 of 124 patients (91.1%), and procedural mortality was low (1 of 124 [0.8%]). Residual MR ≤1+ was achieved in 94.9% at discharge, with stable results at follow-up. The rates of cardiovascular mortality were 14.7% (95% CI: 7.9%-21.5%) and 20.3% (95% CI: 11.4%-29.1%) and of the primary endpoint 44.1% (95% CI: 30.6%-50.0%) and 52.4% (95% CI: 40.2%-62.1%) at 1 and 2 years, respectively, and NYHA functional class had significantly improved at 1- and 2-year follow-up. Atrial fibrillation was an independent predictor of the primary endpoint, whereas technical success was associated with survival.

CONCLUSIONS: TMVR using dedicated TF devices demonstrates favorable safety, durable MR reduction, and sustained functional improvement in high-risk patients. (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency Registry [CHOICE-MI Registry]; NCT04688190).
Date Issued
2026-08-10
Publication Type
Article
Subject(s)
Subjects
mitral regurgitation
•
transcatheter mitral valve replacement
•
transfemoral
Language(s)
en
Author(s)
Strotmann, Lena
Scotti, Andrea
Coisne, Augustin
Heinze, Adrian
Stolz, Lukas
von Stein, Philipp
Ben Ali, Walid
Succar, Camil
Regazzoli, Damiano
Keßler, Mirjam
Duncan, Alison
Rudolph, Tanja K
Heide, Ina von der
Schulz, Carl
Köll, Benedikt
Kalbacher, Daniel
Schofer, Niklas
Nickenig, Georg
Ruge, Hendrik
Adam, Matti
Giannini, Cristina
de Backer, Ole
Adamo, Marianna
Garatti, Andrea
Frerker, Christian
Stiermaier, Thomas
Dahle, Gry
Taramasso, Maurizio
Walther, Thomas
Kempfert, Joerg
Dumonteil, Nicolas
Obadia, Jean-François
Tahirkheli, Naeem
Grygier, Marek
Généreux, Philippe
Bezerra, Hiram G
Wróbel, Krzysztof
Waggoner, Thomas E
Redwood, Simon
Tang, Gilbert H L
Reardon, Michael
Sorajja, Paul
Fam, Neil
Muller, David W
von Bardeleben, Ralph Stephan
Hausleiter, Jörg
Mangieri, Antonio
Ninios, Vlasis
Denti, Paolo
Rottbauer, Wolfgang
Webb, John G
Blankenberg, Stefan
Rodés-Cabau, Josep
Latib, Azeem
Granada, Juan F
Conradi, Lenard
Modine, Thomas
Ludwig, Sebastian
Additional Credits
Journal
JACC: Cardiovascular Interventions
Publisher
Elsevier
ISSN
1876-7605
1936-8798
Access(Rights)
open.access
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