Surgical Redo Mitral Valve Replacement vs. Valve-in-Valve in Failed Bioprosthetic Valves

Despite their higher surgical risk, patients who underwent transcatheter mitral valve replacement (TMVR) presented 1-year mortality rates similar to those of patients who had redo surgical mitral valve replacement for bioprosthetic valve failure.

At one month, echocardiographic findings were similar; however, at one year, patients who underwent TMVR presented a gradient increase that had no clinical relevance. Transcatheter mitral valve replacement has gained ground as an alternative to redo surgery in patients with bioprosthetic mitral valve failure.

This retrospective analysis included 62 patients who underwent TMVR and 59 who underwent surgery. Those who underwent TMVR were older (74.9 ± 9.4 years vs. 63.7 ± 14.9; p < 0.001) and their risk scores were higher (Society of Thoracic Surgeons Predicted Risk of Mortality [STS PROM]: 12.7 ± 8.0% vs. 8.7 ± 10.1%; p < 0.0001) than those of patients who underwent surgery. Despite all of that, procedure time, intensive care unit hours, and length of hospital stay were all shorter for the TMVR group.

Read also: Post-Dilation in Valve-in-Valve Implantation Offers Hemodynamic Improvement.

Additionally, there was no difference in mortality at 1 year between these groups (TMVR 11.3% vs. surgery 11.9%; p = 0.92), which turns TMVR in an increasingly interesting alternative.

At 30 days, there were no echocardiographic differences in terms of mitral regurgitation or gradient. At one year, however, there was a slightly higher gradient in the TMVR group (TMVR 7.2 ± 2.7 vs. surgery 5.5 ± 1.8; p = 0.01), although this difference had no clinical relevance. The grade of regurgitation was similar for both strategies.

Conclusion

Despite the higher risk in patients who underwent transcatheter mitral valve replacement, 1-year outcomes for these patients and younger, lower-risk subjects who underwent redo surgical mitral valve replacement for bioprosthetic valve failure were identical in terms of mortality. The difference in gradient observed at one year seems a mere echocardiographic finding without further significance.

Original title: Comparison of Clinical and Echocardiographic Outcomes After Surgical Redo Mitral Valve Replacement and Transcatheter Mitral Valve-in-Valve Therapy.

Reference: Norihiko Kamioka et al. J Am Coll Cardiol Intv 2018;11:1131-8.

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