Transcatheter mitral valve replacement for degenerated mitral valve bioprostheses, failure of mitral valvuloplasty and native valve with severe mitral annulus calcification: a systematic review and meta-analysis

Abstract

Background Although transcatheter technology has achieved some success in the field of mitral valves, the feasibility of applying it to patients with degenerated mitral valve bioprostheses (valve-in-valve, ViV), failure of mitral valvuloplasty (valve-in-ring, ViR) and serious mitral annulus calcification (vale-in-MAC, ViMAC) has not been effectively evaluated. Methods By searching published literature before December 5, 2020 in four databases, we found all the literature related to the evaluation of feasibility assessment of TMViV, TMViR and TMViMAC. Outcomes focused on all-cause mortality within 30 days, bleeding and LVOT obstruction. Results A total of six studies were included, and all of them were followed up for at least 30 days. After analysis of the ViV–ViR group, we obtained the following results: the all-cause mortality within 30 days of the ViV group was lower than that of the ViR group. Life-threatening or fatal bleeding was more likely to occur in the ViR group after surgery. At the same time, the ViR group was more prone to left ventricular outflow tract obstruction. However, in the ViMAC–ViR group, only the all-cause mortality within 30 days and stroke were statistically significant. In the indirect comparison, we found that TMViV had the best applicability, followed by TMViR. There were few TMViMAC available for analysis, and it requires further studies to improve the accuracy of the results. Conclusion TMViV and TMViR had good applicability and could benefit patients who underwent repeat valve surgery. The feasibility of TMViMAC needs to be further explored and improved.

Valve-in-valve transcatheter transfemoral mitral valve implantation (ViV-TMVI): Characteristics and early results from a nationwide registry

“…cerebrovascular, bleeding/vascular, or repeat surgery. Other larger international cohort studies reported 30-day mortality reaching up to 8% with other adverse events also more frequently occurring when describing outcomes of early experiences [12]. These promising clinical results coming from this first experience in Poland are probably attributable to the later adoption of this technique in Poland and thereby avoidance of most of the issues characteristic of early stages of ViV-TMVI (e.g.…”

Noncontrast cardiac computed tomography‐derived mitral annular calcification scores in mitral valve disease

“…Guerrero et al 8 performed transcatheter MV replacement for patients with severe MAC who were not surgical candidates, they found cardiac‐CT based score provided a systematic method to grade MAC severity which may assist in predicting valve embolization/migration. A meta‐analysis showed that the feasibility of transcatheter technology in serious MAC needed to be further explored and improved 42 . The experience in this aspect is still limited and general recommendations cannot yet be made 16 .…”

“…A meta‐analysis showed that the feasibility of transcatheter technology in serious MAC needed to be further explored and improved. 42 The experience in this aspect is still limited and general recommendations cannot yet be made. 16 But what is certain is that imaging is critical to the success of these surgical and transcatheter therapies.…”

Minimally invasive valve surgery: pushing boundaries over the eighty

“…[25,26] In the era of micro-invasive procedures, transcatheter valve repair or replacement should be definitely be considered an alternative to traditional or minimally invasive cardiac surgery in fragile and high-risk patients such as octogenarians. [27] However, it is well-known that micro-invasive procedures have strict parameters of selection, particularly regarding the anatomy of the MV or TV; therefore, a not negligible proportion of patients are excluded from the benefits of these options. Moreover, wh-en looking at micro-invasive options for MV replacement, suboptimal outcomes in terms of in-hospital mortality and weaknesses of the procedure, such as iatrogenic left ventricular outflow tract obstruction and MV stenosis, are still reported and represent a restraint in the broader adoption of these techniques.…”