Outcomes of rescue procedures in patients undergoing unsuccessful deployment of transcatheter mitral valve replacement.
- 1Department of Cardiothoracic Surgery, Albany Medical Center, 50New Scotland Ave, Albany, 12208, NY, Australia. [email protected].
- 2Department of Cardiothoracic Surgery, Albany Medical Center, 50New Scotland Ave, Albany, 12208, NY, Australia.
- 3Department of Cardiology, Capital Cardiology Associates, Albany, NY, Australia.
Abstract
Background
Perivalvular leak (PVL), valve embolization, and migration of valve in mitral position are critical complications of transcatheter mitral valve replacement (TMVR). To date, rescue strategies, and outcomes following unsuccessful initial TMVR deployment remain poorly documented.Methods
Between March 2016 and December 2024, 86 patients with high risk of open-heart surgery underwent TMVR with a balloon expandable valve at a single institution. 19.8% (17/86) of patients experienced unsuccessful first TMVR (unsuccessful group) due to valve embolization, migration, significant PVL, or pericardial effusion, whereas 80.2% (69/86) had successful first TMVR (successful group). We evaluated postoperative outcomes comparing unsuccessful to successful groups.Results
Among 17 patients with unsuccessful first TMVR, 70.6% (12/17) underwent additional valve deployment, with successful valve-in-valve implantation in 75.0% (9/12). 17.6% (3/17) developed valve embolization in left atrium after transcatheter rescue procedures or additional valve deployment failed, subsequently 66.7% (2/3) required emergent surgical explantation of embolized valves, 33.3% (1/3) was managed medically due to prohibitive surgical risk. Surgical patients were discharged home without complications. Early mortality in unsuccessful group was 29.4% (5/17) and 13.0% (9/69) in successful group. There was no significant difference in early mortality between the 2 groups (p = 0.10). Median follow-up term was 10 months. Cumulative survival rate in 12 months was 50.5% in unsuccessful group, and 60.0% in successful group. Mid-term outcomes were similar between the 2 groups (p = 0.34).Conclusions
The study was underpowered to detect differences in all-cause mortality, but unsuccessful deployment was associated with substantially higher numerical early mortality and significantly higher cardiac mortality.
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BibTeX
@article{nakai2026outcomes,
title = {{Outcomes of rescue procedures in patients undergoing unsuccessful deployment of transcatheter mitral valve replacement.}},
author = {Chikashi Nakai and Junyi Liu and Mei Xing Zuo and Saeed Tarabichi and Augustin DeLago},
journal = {Journal of cardiothoracic surgery},
year = {2026},
month = jul,
doi = {10.1186/s13019-026-04666-w},
url = {https://europepmc.org/article/MED/42902399},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Outcomes of rescue procedures in patients undergoing unsuccessful deployment of transcatheter mitral valve replacement.
AU - Chikashi Nakai
AU - Junyi Liu
AU - Mei Xing Zuo
AU - Saeed Tarabichi
AU - Augustin DeLago
PY - 2026
DA - 2026/07/01
JO - Journal of cardiothoracic surgery
DO - 10.1186/s13019-026-04666-w
UR - https://europepmc.org/article/MED/42902399
AB - Background Perivalvular leak (PVL), valve embolization, and migration of valve in mitral position are critical complications of transcatheter mitral valve replacement (TMVR). To date, rescue strategies, and outcomes following unsuccessful initial TMVR deployment remain poorly documented.Methods Between March 2016 and December 2024, 86 patients with high risk of open-heart surgery underwent TMVR with a balloon expandable valve at a single institution. 19.8% (17/86) of patients experienced unsuccessful first TMVR (unsuccessful group) due to valve embolization, migration, significant PVL, or pericardial effusion, whereas 80.2% (69/86) had successful first TMVR (successful group). We evaluated postoperative outcomes comparing unsuccessful to successful groups.Results Among 17 patients with unsuccessful first TMVR, 70.6% (12/17) underwent additional valve deployment, with successful valve-in-valve implantation in 75.0% (9/12). 17.6% (3/17) developed valve embolization in left atrium after transcatheter rescue procedures or additional valve deployment failed, subsequently 66.7% (2/3) required emergent surgical explantation of embolized valves, 33.3% (1/3) was managed medically due to prohibitive surgical risk. Surgical patients were discharged home without complications. Early mortality in unsuccessful group was 29.4% (5/17) and 13.0% (9/69) in successful group. There was no significant difference in early mortality between the 2 groups (p = 0.10). Median follow-up term was 10 months. Cumulative survival rate in 12 months was 50.5% in unsuccessful group, and 60.0% in successful group. Mid-term outcomes were similar between the 2 groups (p = 0.34).Conclusions The study was underpowered to detect differences in all-cause mortality, but unsuccessful deployment was associated with substantially higher numerical early mortality and significantly higher cardiac mortality.
SN - 1749-8090
ER -