Valvular & structural heart disease
5-Year Prospective Evaluation of Mitral Valve-in-Valve, Valve-in-Ring, and Valve-in-MAC Outcomes: MITRAL Trial Final Results
Authors' conclusion
MViV, MViR, and ViMAC procedures were associated with sustained improvement of heart failure symptoms and quality of life among survivors at 5 years. Transcatheter heart valve function remained stable in all 3 groups. Patients treated with MViV had excellent survival at 5 years, whereas survival was lower in the MViR and ViMAC groups, consistent with underlying disease severity. Patients with more residual mitral regurgitation had higher mortality.
Study context
- Population
- Patients at high surgical risk with failed surgical bioprostheses or annuloplasty rings, or severe mitral annular calcification
- Participants
- 91 patients
- Exposure
- Mitral valve-in-valve (MViV) vs MViR vs valve-in-mitral annular calcification (ViMAC) with balloon-expandable aortic transcatheter heart valves
- MViVn = 30
- MViRn = 30
- ViMACn = 31
- Outcome
- All-cause mortality, NYHA class I or II, mean mitral gradient
- Follow-up
- 5 years
Methodological details13 US sites, independent echocardiography core laboratories
- 13 US sites
- Independent echocardiography core laboratories
Main finding
As reported in the abstract
All-cause mortality
| Outcome | MViV | MViR | ViMAC |
|---|---|---|---|
| NYHA class I or II | 94.7% | — not stated in the abstract | — not stated in the abstract |
| Mean mitral gradient | 6.6 ± 2.5 mm Hg | 5.8 ± 0.1 mm Hg | 6.7 ± 2.5 mm Hg |
| NYHA class I or II (survivors) | — not stated in the abstract | 50% | 55.6% |
— not stated in the abstract
Observational data: associations, not effects.
Further findings
- Significant improvements in KCCQ scores when all 3 arms were pooled
Original publication
5-Year Prospective Evaluation of Mitral Valve-in-Valve, Valve-in-Ring, and Valve-in-MAC Outcomes: MITRAL Trial Final Results. JACC Cardiovasc Interv. Published 25 September 2023. doi:10.
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