Valvular & structural heart disease

Transmitral Gradients and Mortality Following Transseptal Transcatheter Mitral Valve in Valve

JACC Cardiovasc IntervPublished Registry-based cohort study

Authors' conclusion

Following MVIV, TMG <4 mm Hg was associated with lower CO and cardiac index and increased mortality at 3 years compared with TMG 4 to 7 mm Hg and >7 mm Hg.

Study context

Population
All comers undergoing transcatheter mitral valve in valve (MVIV), August 2015 to March 2024896 mortality events
Participants
5,401 participants
Exposure
Low vs intermediate vs high discharge transmitral gradient after MVIV
Outcome
All-cause mortality
Follow-up
3 years
Methodological detailsSTS/ACC TVT Registry, adjusted Cox proportional hazards models
  • STS/ACC TVT Registry
  • Adjusted Cox proportional hazards models

Main finding

As reported in the abstract

All-cause mortality by discharge TMG
Adjusted hazard ratio (95% CI)P value
Low TMGvs Intermediate TMG
1.52(1.22–1.89)
P = 0.0002
Low TMGvs High TMG
1.35(1.07–1.71)
P = 0.01

Observational data: associations, not effects.

Further findings

OutcomeP value
Invasive cardiac outputLow TMG vs Intermediate TMG · lower with low TMGP = 0.0003
Invasive cardiac outputLow TMG vs High TMG · lower with low TMGP < 0.0001
Cardiac indexLow TMG vs Intermediate TMG · lower with low TMGP = 0.04
Cardiac indexLow TMG vs High TMG · lower with low TMGP = 0.0002

Discharge vs 30-day gradient groups

Discharge and 30-day gradient groups varied and should not be interchangeable

Original publication

Transmitral Gradients and Mortality Following Transseptal Transcatheter Mitral Valve in Valve. JACC Cardiovasc Interv. Published 13 April 2026. doi:10.1016/j.jcin.2025.12.026

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