Reasons for Screen Failure for Transcatheter Mitral Valve Repair and Replacement. - 2021

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

Despite an expanding armamentarium of devices, many patients with mitral regurgitation referred for transcatheter mitral valve repair (TMVr) or replacement (TMVR) do not meet strict clinical trial inclusion and exclusion criteria. We sought to understand the rates that patients were excluded from transcatheter mitral valve therapies and reasons why. We retrospectively analyzed the medical charts and correspondence related to patients referred to our tertiary valve center for TMVr or TMVR between June 2016 and September 2019. Patients were screened for eligibility by our structural Heart Team for either TMVr or TMVR. If TMVr or TMVR was not offered, the reason for screen failure was recorded and categorized. Over the 3-year period, 564 patients were referred for TMVr and orTMVR. Out of these, 15.9% were determined to be eligible for, and underwent, surgical repair or replacement. Ninety-two patients (16.3%) underwent TMVr or TMVR. The majority of patients (343 of 564, 60.8%) ultimately did not undergo intervention. The primary reason for exclusion was clinical in 38.5%, issues related to patient preference of care delivery in 38.8%, anatomical in 13.7%, and futility in 9.0%. In contemporary real-world practice, the majority of patients with mitral regurgitation referred for transcatheter therapies are excluded. Clinical trials testing new transcatheter devices should be encouraged to record and report reasons for screen failure and follow these patients to better understand optimal timing of intervention, address challenging anatomies, and, ultimately, improve penetrance of these novel therapies. Copyright (c) 2021. Published by Elsevier Inc.


English

0002-9149

10.1016/j.amjcard.2021.02.022 [doi] S0002-9149(21)00197-1 [pii]


IN PROCESS -- NOT YET INDEXED


MedStar Health Research Institute
MedStar Heart & Vascular Institute
MedStar Washington Hospital Center


Internal Medicine & Pediatrics Residency
Internal Medicine Residency
Interventional Cardiology Fellowship


Journal Article