Logo image
Back
Mitral Valve-in-Valve Versus Repeat Surgical Mitral Valve Replacement in Patients With Failed Mitral Bioprostheses
Journal article   Open access   Peer reviewed

Mitral Valve-in-Valve Versus Repeat Surgical Mitral Valve Replacement in Patients With Failed Mitral Bioprostheses

Abdullah Al-Abcha, Yehia Saleh, Safi U. Khan, Adolfo Martinez Salazar, Syed Zaid, Ola Abdelkarim, Adnan Halboni, Omar M. Abdelfattah, Sachin S. Goel, Neal S. Kleiman, …
Journal of the Society for Cardiovascular Angiography & Interventions, Vol.2(1), p.100516
01/2023
DOI: 10.1016/j.jscai.2022.100516
PMCID: PMC11307612
PMID: 39132537
url
https://doi.org/10.1016/j.jscai.2022.100516View
Published (Version of record) Open Access

Abstract

Transcatheter mitral valve-in-valve (MViV) replacement has emerged as an alternative to redo surgical mitral valve replacement (redo-SMVR) in patients with failed mitral bioprostheses deemed to be at a high surgical risk. The aim of this analysis was to compare the outcomes of MViV replacement with those of redo-SMVR in patients with a failed bioprosthetic mitral valve. We performed a study-level meta-analysis that compared MViV replacement with redo-SMVR in patients with failed mitral bioprostheses. Seven observational studies, with a total of 5083 patients, were included (1138 patients [22.4%] in the MViV replacement arm). The primary focus was all-cause mortality. Additional outcomes included major bleeding, stroke, vascular complications, and mean mitral valve gradient at follow-up. The in-hospital mortality was lower in patients who underwent MViV replacement than in those who underwent redo-SMVR (odds ratio [OR], 0.64; 95% CI, 0.53-0.78; P = .0023). The short-term mortality (<1 year) was numerically lower in the MViV replacement group (OR, 0.45; 95% CI, 0.18-1.13; P = .069). At 1 year, the risk of mortality was similar in the 2 groups (OR, 0.99; 95% CI, 0.69-1.40; P = .906), and at midterm follow-up (≥1 year), there was a numerically higher risk of mortality in the MViV replacement group (OR, 1.51; 95% CI, 1.00-2.29; P = .051). The risk of major bleeding was significantly lower in the MViV replacement group (OR, 0.23; 95% CI, 0.10-0.56; P = .01). Additionally, stroke and vascular complications were similar between the 2 groups. The in-hospital mortality was lower in the MViV replacement group than in the redo-SMVR group. There were no differences in mortality at short-term (<1 year), 1-year, or midterm (≥1 year) follow-ups. [Display omitted] •In patients with failed mitral bioprostheses, transcatheter mitral valve replacement is associated with lower short-term mortality.•Transcatheter mitral valve replacement using a transseptal approach has midterm mortality comparable to redo surgical replacement.•The risk of major bleeding was significantly lower in the transcatheter mitral valve replacement arm.•The risk of stroke and vascular complications were similar in both the arms.
 failed bioprosthetic mitral valve redo surgical aortic valve replacement transcatheter mitral valve replacement

Details

Metrics

6 Record Views
Logo image