Meta-Analysis Comparing Valve in Valve Transcatheter Mitral Valve Replacement Versus Redo Surgical Mitral Valve Replacement for Degenerating Bioprosthetic Valves

Zahid, Salman; Ullah, Waqas; Khan, Muhammad Usman; Sarvepalli, Deepika; Inayat, Arslan; Salman, Fnu

doi:10.1016/j.amjcard.2021.03.005

Cited by 12 publications

(7 citation statements)

References 6 publications

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“…Nonetheless, there was no difference in the survival between the groups. While redo SMVR is known to carry a high periprocedural and postoperative mortality risk, mortality rates of the present study are in line with those reported in previous studies [ 2 , 7 , 8 ]. A study published by Kamioka et al evaluating the results of 59 patients undergoing either TMVR of SMVR reported no significant difference in the survival of both procedures [ 9 ], which was proven by our results.…”

Section: Discussionsupporting

confidence: 93%

“…Over the past decades, transcatheter methods have been rapidly evolving to provide an alternative less invasive therapeutic option, mainly owing to the fact that redo patients often present with multiple comorbidities and a high operative risk. Although, recent studies have demonstrated the feasibility of transcatheter methods in redo valve procedures, there are only few large studies comparing surgical and interventional methods [ 2 ]. The aim of this study is to evaluate our experience with surgical redo SMVR and transapical transcatheter mitral valve replacement (TA-TMVR).…”

Section: Introductionmentioning

confidence: 99%

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Mitral surgical redo versus transapical transcatheter mitral valve implantation

et al. 2021

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Background Transcatheter methods have been rapidly evolving to provide an alternative less invasive therapeutic option, mainly because redo patients often present with multiple comorbidities and high operative risk. We sought to evaluate and compare our experience with transapical transcatheter mitral valve replacement (TA-TMVR) to conventional redo mitral valve replacement in patients presenting with degenerated biological mitral valve prostheses or failed valve annuloplasty. Methods and material Between March 2012 and November 2020, 74 consecutive high-risk patients underwent surgical redo mitral valve replacement (n = 33) or TA-TMVR (n = 41) at our institution. All patients presented with a history of a surgical mitral valve procedure. All transcatheter procedures were performed using the SAPIEN XT/3™ prostheses. Data collection was prospectively according to MVARC criteria. Results The mean logistic EuroSCORE-II of the whole cohort was 19.9±16.7%, and the median STS-score was 11.1±12.5%. The mean age in the SMVR group was 63.7±12.8 years and in the TMVR group 73.6±9.7 years. Patients undergoing TA-TMVR presented with significantly higher risk scores. Echocardiography at follow up showed no obstruction of the left ventricular outflow tract, no paravalvular leakage and excellent transvalvular gradients in both groups (3.9±1.2 mmHg and 4.2±0.8 mmHg in the surgical and transcatheter arm respectively). There was no difference in postoperative major adverse events between the groups with no strokes in the whole cohort. Both methods showed similar survival rates at one year and a 30-day mortality of 15.2% and 9.8% in SAVR and TMVR group, respectively. Despite using contrast dye in the transcatheter group, the rate of postoperative acute kidney failure was similar between the groups. Conclusion Despite several contraindications for surgery, we showed the non-inferiority of TA-TMVR compared to conventional surgical redo procedures in high-risk patients. With its excellent hemodynamic and similar survival rate, TA-TMVR offers a feasible alternative to the conventional surgical redo procedure in selected patients.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Mitral surgical redo versus transapical transcatheter mitral valve implantation

et al. 2021

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“…Valve surgery mortality increases proportionally to the number of previous operations, reaching the prohibitive value of 40% in the fourth mitral valve replacement ( 7 , 32 ). Recent meta-analysis showed that ViV is associated with lower rate of MACE, bleeding and short hospitalization complications when compared to re-do surgery, being a reasonable treatment option ( 33 ). Besides, ViV procedure does not contraindicate further surgical or transcatheter procedures in the future, which is one of the advantages of transcatheter procedure.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Valve-in-Valve Procedures for Bioprosthetic Valve Dysfunction in Patients With Rheumatic vs. Non-Rheumatic Valvular Heart Disease

Lopes

Rosa

Palma

et al. 2021

Front. Cardiovasc. Med.

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Background: Bioprosthetic heart valve has limited durability and lower long-term performance especially in rheumatic heart disease (RHD) patients that are often subject to multiple redo operations. Minimally invasive procedures, such as transcatheter valve-in-valve (ViV) implantation, may offer an attractive alternative, although data is lacking. The aim of this study was to evaluate the baseline characteristics and clinical outcomes in rheumatic vs. non-rheumatic patients undergoing ViV procedures for severe bioprosthetic valve dysfunction.Methods: Single center, prospective study, including consecutive patients undergoing transcatheter ViV implantation in aortic, mitral and tricuspid position, from May 2015 to September 2020. RHD was defined according to clinical history, previous echocardiographic and surgical findings.Results: Among 106 patients included, 69 had rheumatic etiology and 37 were non-rheumatic. Rheumatic patients had higher incidence of female sex (73.9 vs. 43.2%, respectively; p = 0.004), atrial fibrillation (82.6 vs. 45.9%, respectively; p < 0.001), and 2 or more prior surgeries (68.1 vs. 32.4%, respectively; p = 0.001). Although, device success was similar between groups (75.4 vs. 89.2% in rheumatic vs. non-rheumatic, respectively; p = 0.148), there was a trend toward higher 30-day mortality rates in the rheumatic patients (21.7 vs. 5.4%, respectively; p = 0.057). Still, at median follow-up of 20.7 [5.1–30.4] months, cumulative mortality was similar between both groups (p = 0.779).Conclusion: Transcatheter ViV implantation is an acceptable alternative to redo operations in the treatment of patients with RHD and severe bioprosthetic valve dysfunction. Despite similar device success rates, rheumatic patients present higher 30-day mortality rates with good mid-term clinical outcomes. Future studies with a larger number of patients and follow-up are still warranted, to firmly conclude on the role transcatheter ViV procedures in the RHD population.

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“…Further evaluation with the MITRAL early feasibility study further supports the safety and efficacy of this strategy demonstrating robust results when used in the setting of valve‐in‐valve (MViV), 5 valve‐in‐ring (MViR), 6 and valve‐in‐mitral annular calcification (MViMAC) 7 . To date, however, only short term outcomes for TMVR and SMVR have been reported, 8,9 with meta‐analyses suggesting improved outcomes with TMVR 10 . Herein, we report mid‐term outcomes in patients managed via transcatheter mitral valve replacement (TMVR) or redo SMVR for degenerated mitral valve prostheses.…”

Section: Introductionmentioning

confidence: 86%

Five‐year outcomes of transcatheter mitral valve implantation and redo surgery for mitral prosthesis degeneration

Simard

Lloyd

Crestanello

et al. 2022

Cathet Cardio Intervent

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Background Transcatheter mitral valve replacement (TMVR) has emerged as a feasible alternative to redo surgical mitral valve replacement (SMVR) in patients with degenerated mitral prostheses, with limited comparative data. Methods We compared mid‐term outcomes in patients with degenerated mitral valve prostheses treated with TMVR or redo SMVR. The primary endpoint was survival at 5 years of follow‐up. Results From 2014 to 2020, 215 patients presented with degenerated mitral valve prostheses. Of whom 86 (40%) were treated with TMVR (75[87%] valve‐in‐valve and 11[13%] valve‐in‐ring), while 129 patients (60%) underwent SMVR. The TMVR cohort was older (p < 0.0001), more symptomatic (p = 0.0003) and had more chronic lung disease (p = 0.02), worse renal function (p = 0.02) and higher right ventricular systolic pressures (p < 0.0001). Thirty‐day mortality was lower with TMVR versus SMVR (2.4% vs. 10.2%, OR4.69 [95% CI 1.25–30.5], p = 0.04) with probability of mortality at 1, 2, and 5 years being 14.7% versus 17.5%, 24.5% versus 20.7%, and 49.9% versus 34.0%, respectively. Mode of prosthesis degeneration, baseline hemodynamics, and valve selection did not appreciably impact outcomes. Conclusions TMVR for degenerated mitral prostheses is associated with better early survival compared to SMVR despite a greater burden of comorbidities. In contrast, 5 year survival rates appear more favorable with SMVR, which may reflect the lower baseline risk of this population. Clinical, hemodynamic, and echocardiographic follow‐up support the mid‐term durability of TMVR for degenerated mitral prostheses. Further dedicated studies, however, are required to optimize outcomes in this challenging patient cohort and to navigate the choice of approach for each individual patient.

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Meta-Analysis Comparing Valve in Valve Transcatheter Mitral Valve Replacement Versus Redo Surgical Mitral Valve Replacement for Degenerating Bioprosthetic Valves

Cited by 12 publications

References 6 publications

Mitral surgical redo versus transapical transcatheter mitral valve implantation

Mitral surgical redo versus transapical transcatheter mitral valve implantation

Transcatheter Valve-in-Valve Procedures for Bioprosthetic Valve Dysfunction in Patients With Rheumatic vs. Non-Rheumatic Valvular Heart Disease

Five‐year outcomes of transcatheter mitral valve implantation and redo surgery for mitral prosthesis degeneration

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