• mitral regurgitation
• mitral valve
• Tendyne System
• TMVR

BACKGROUND In recent years, transcatheter mitral valve replacement (TMVR) has gained much attention, in addition to mitral transcatheter edge-to-edge repair, for patients with severe mitral valve regurgitation (MR) who are considered at high risks for traditional open-heart surgery.
OBJECTIVES This study is aimed to analyze the prognosis of patients undergoing transcatheter mitral valve replacement through a transapical approach with the Tendyne bioprosthesis in a single centre experience. In addition, we investigated the effects of TMVR on right heart function.
METHODS All patients who underwent TMVR with the Tendyne system from November 2018 to March 2024 were enrolled, regardless of the etiology of mitral regurgitation. One-month and one year clinical and echocardiographic follow-up was performed. In particular, with estimated pulmonary artery systolic pressure (sPAP), tricuspid annulus systolic excursion (TAPSE), and their ratio as an index of right ventricle-to-pulmonary artery coupling (RVPAc), with a threshold of RVPAc <0.4 to define impaired right ventricular function.
RESULTS 32 patients underwent TMVR in our centre; mean age was 74,5 ± 7, 7 years, 42% were men, with a mean Society of Thoracic Surgeons (STS) predicted risk of mortality of 4,5  3,7%, and a mean European System for Cardiac Operative Risk Evaluation (Euroscore) of 6,4  5,8%. Most patients (62,5%) were in NYHA functional class III, and showed a severe degree of MR. The technical success rate of TMVR was 100%, with absence of residual intravalvular or paravalvular MR in all patients. All-cause mortality was 10% and 30% at 1 month and 1 year follow-up, respectively. No patient required mitral reintervention during follow-up. At 1 year follow up 80% were in NYHA class II and 20% were in NYHA class I. An improvement in right heart function at 1 month follow-up was demonstrated by the reduction in mean sPAP values from 45 ± 12 mmHg to 36 ± 8 mmHg and by the reduction in the prevalence of RVPAc <0.4 from 41% to 15% The lack of reduction in mean sPAP at 30 days was a predictor of mortality at 1 year.
CONCLUSIONS In our experience, TMVR with the Tendyne system allows for the complete elimination of MR, with ensuing clinical benefits at 30 days and 1 year follow up in most patients. We also observed an early improvement in pulmonary artery systolic pressure and in RVPAc. The lack of an improvement in sPAP at 30 days was associated with worse overall survival at 1-year follow-up.