Interdisciplinary periprocedural management of patients undergoing transapical tmvi with the tendyne™ system: A narrative review and institutional experience.

Abstract

Objectives: Mitral regurgitation (MR) represents the most common valvular heart disease (VHD) in the Western world. While transcatheter mitral valve repair (M-TEER) is the leading interventional treatment for surgically high-risk patients, transcatheter mitral valve implantation (TMVI) is reserved for selected patients with unsuitable anatomy for M-TEER. This review aims to summarize our institutional experience with TMVI using the Tendyne™ valve (Abbott Vascular, CA, USA), focusing on interdisciplinary preoperative, intraoperative, and postoperative management strategies.

Methods: We conducted a narrative review of current literature on TMVI with the Tendyne™ system and integrated it with a comprehensive analysis of our interdisciplinary clinical experience. Data were collected regarding patient selection, imaging protocols, procedural techniques, and postoperative care.

Results: Utilizing the Tendyne™ valve, TMVI addresses symptomatic moderate-to-severe or severe MR in patients unsuitable for conventional surgery or transcatheter mitral valve repair (M-TEER). Successful outcomes require thorough patient selection, including assessment for minimal mitral annular calcification, absence of intracardiac thrombus, low left ventricular outflow tract (LVOT) obstruction risk, and optimal annular sizing. Multimodal imaging, particularly transoesophageal echocardiography and cardiac computed tomography, is essential for procedural planning and execution. TMVI is performed under general anaesthesia with intraoperative transoesophageal guidance and haemodynamic monitoring to minimize complications such as LVOT obstruction, bleeding, and valve malposition. Postoperative management emphasizes haemodynamic stabilization, bleeding control, and surveillance for paravalvular leaks or device dysfunction.

Conclusions: TMVI with the Tendyne™ valve provides a viable and effective treatment for selected patients with symptomatic moderate to severe MR. Optimal outcomes are dependent on meticulous interdisciplinary collaboration, advanced imaging protocols, and comprehensive perioperative management.