Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve in Valve From the National Inpatient Sample

Abstract

Background Redo mitral valve surgery is required in up to one‐third of patients and is associated with significant mortality and morbidity. Valve‐in‐valve transcatheter mitral valve replacement (ViV TMVR) is less invasive and could be considered in those at prohibitive surgical risk. Studies on comparative outcomes of ViV TMVR and redo surgical mitral valve replacement (SMVR) remain limited. Our study aimed to investigate the real‐world outcomes of the above procedures using the National Inpatient Sample database. Methods and Results We analyzed National Inpatient Sample data using the International Classification of Diseases, Tenth Revision, Clinical Modification ( ICD‐10‐CM ) from September 2015 to December 2018. A total of 495 and 2250 patients underwent redo ViV TMVR and SMVR, respectively. The patients who underwent ViV TMVR were older (77 versus 68 years, P <0.01). Adjusted mortality was higher in the redo SMVR group compared with the ViV TMVR group (7.6% versus <2.8%, P <0.01). Perioperative complications were higher among patients undergoing redo SMVR including blood transfusions (38% versus 7.6%, P <0.01) and acute kidney injury (36.7% versus 13.9%, P <0.01). Cost of care was higher (USD$57 172 versus USD$52 579, P <0.01), length of stay was longer (10 versus 3 days, P <0.01), and discharge to home was lower (20.3% versus 64.6%, P <0.01) in the SMVR group compared with the ViV TMVR group. Conclusions ViV TMVR is associated with lower mortality, periprocedural morbidity, and resource use compared with patients undergoing redo SMVR. ViV TMVR may be a viable option for some patients with mitral prosthesis dysfunction. Studies evaluating long‐term outcomes and durability of ViV TMVR are needed. A patient‐centered approach by the heart team, local institutional expertise, and careful preprocedure planning can help decision‐making about the choice of intervention for the individual patient.

Transcatheter Mitral Valve-in-valve Implantation with the Balloon-expandable Myval Device

“…ViV TMVR represents an attractive alternative to redosurgical MVR in patients with a degenerated bioprosthesis and is associated with lower mortality, periprocedural morbidity, and resource use compared to redo-surgery. 5 Preoperative decision-making and planning play key roles in achieving a successful ViV TMVR. Assessment of the surgical prosthesis type and left ventricular anatomy are of considerable importance for the patient's eligibility for ViV TMVR.…”

“…The introduction of ViV TMVR has significantly dropped the number of in-hospital deaths, the length of hospital stay, and the risk of complications compared to conventional redo-MVR surgery. 5 Therefore, the implementation of ViV TMVR in patients with structural valve deterioration is of major clinical interest.…”

Transcatheter mitral valve replacement versus redo surgery for mitral prosthesis failure: A systematic review and meta-analysis

“…However, redo SMVR is associated with an increased operative risk due to a number of factors, such as comorbidities and broad adhesions ( 14 ). For patients at a high surgical risk, TMVR is another viable treatment option ( 15 ). Following the development of transcatheter technologies in aortic valve replacement, transcatheter mitral valve-in-valve or valve-in-ring implantation has recently also been rapidly developing as an alternative to conventional surgical mitral valve redo procedures ( 16 , 17 ).…”

Valve-in-valve/valve-in-ring transcatheter mitral valve implantation vs. redo surgical mitral valve replacement for patients with failed bioprosthetic valves or annuloplasty rings: A systematic review and meta-analysis

“…For data in the form of interquartile ranges, if the sample size was large and the data distribution was close to normal (none of the included studies met these requirements), the mean was calculated using a validated formula. In one article [ 10 ], the value of the continuity variable was given as < 11. In that particular article, the larger the value, the worse the results were for the ViV/ViR TMVI group.…”