Zillner Liliane, Wild Mirjam G, Hell Michaela M, Herkner Harald, Kuhn Elmar W, Rudolph Tanja, Walther Thomas, Conradi Lenard, Zierer Andreas, Maisano Francesco, Russo Marco, Rosati Fabrizio, Colli Andrea, Piñón Miguel, Reineke David, Aphram Gaby, Kerbel Tillmann, Dubois Christophe, Hausleiter Jörg, von Bardeleben Ralph Stephan, Mach Markus, Loewe Christian, Andreas Martin
Department of Cardiac and Thoracic Aortic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
Medizinische Klinik I, LMU University Hospital, 80336 Munich, Germany.
J Clin Med. 2025 Jun 20;14(13):4412. doi: 10.3390/jcm14134412.
: The Tendyne™ transcatheter heart valve (THV) system is a promising option for high-risk patients with severe mitral regurgitation (MR) who are ineligible for surgery or transcatheter edge-to-edge repair (TEER). As most fatal complications occur within the first 90 days, this study aimed to identify anatomical predictors of in-hospital mortality after transcatheter mitral valve replacement (TMVR). In this subanalysis of the TENDER registry, data from 110 patients who underwent TMVR across 26 centers between January 2020 and June 2022 were evaluated. Preprocedural imaging parameters were analyzed, including transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and cardiac 4D computed tomography (CT). We identified LVEDDi as a significant predictor of in-hospital mortality ( = 0.022), with lower values in non-survivors (26.42 ± 3.76 mm/m) than in survivors (30.37 ± 5.58 mm/m). Both indexed and absolute LVEDDi predicted in-hospital complications ( < 0.001 and = 0.008). In multivariate analysis, LVEDDi ( = 0.048; OR = 0.856) and STS score ( = 0.038; OR = 1.114) remained independent predictors of in-hospital mortality. In an extended model, only LVEDDi persisted as a significant predictor ( = 0.007), highlighting its robustness. : This analysis identified a small LVEDDi as a novel, clinically relevant risk factor in TMVR and showed its added value alongside conventional markers. Its easy calculation supports incorporating LVEDDi thresholds into screening to improve patient selection and outcomes.
Tendyne™经导管心脏瓣膜（THV）系统对于因手术或经导管缘对缘修复（TEER）不适用而患有严重二尖瓣反流（MR）的高危患者来说是一个有前景的选择。由于大多数致命并发症发生在最初90天内，本研究旨在确定经导管二尖瓣置换术（TMVR）后院内死亡的解剖学预测因素。在这项TENDER注册研究的亚分析中，评估了2020年1月至2022年6月期间在26个中心接受TMVR的110例患者的数据。分析了术前成像参数，包括经胸超声心动图（TTE）、经食管超声心动图（TEE）和心脏四维计算机断层扫描（CT）。我们确定左心室舒张末期内径（LVEDDi）是院内死亡的一个重要预测因素（P = 0.022），非幸存者的LVEDDi值（26.42±3.76 mm/m）低于幸存者（30.37±5.58 mm/m）。指数化和绝对LVEDDi均预测院内并发症（P < 0.001和P = 0.008）。在多变量分析中，LVEDDi（P = 0.048；OR = 0.856）和胸外科医师协会（STS）评分（P = 0.038；OR = 1.114）仍然是院内死亡的独立预测因素。在一个扩展模型中，只有LVEDDi仍然是一个重要预测因素（P = 0.007），突出了其稳健性。：该分析确定小LVEDDi是TMVR中一个新的、具有临床相关性的危险因素，并显示了其与传统标志物相比的附加价值。其易于计算支持将LVEDDi阈值纳入筛查，以改善患者选择和治疗结果。
