Meta-Analysis Comparing Valve-in-Valve Transcatheter Mitral Valve Replacement Versus Redo Surgical Mitral Valve Replacement in Degenerated Bioprosthetic Mitral Valve

Authors

Mahmoud Ismayl, Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska.
Muhannad Aboud Abbasi, Division of Cardiovascular Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Mostafa Reda Mostafa, Rochester Regional HealthFollow
Ahmed Aboeata, Division of Cardiovascular Medicine, Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska.
Amit N. Vora, UPMC Heart and Vascular Institute, Harrisburg, Pennsylvania.
Itsik Ben-Dor, Division of Interventional Cardiology, Medstar Washington Hospital Center, Washington District of Columbia.
Nandan S. Anavekar, Division of Cardiovascular Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Andrew M. Goldsweig, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.

Department

Internal Medicine

Document Type

Article

Publication Title

The American Journal of Cardiology

Abstract

Valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) and redo surgical mitral valve replacement (redo-SMVR) are 2 treatment strategies for patients with bioprosthetic mitral valve dysfunction. We conducted a systematic review and meta-analysis to compare the outcomes of ViV-TMVR versus redo-SMVR. We searched PubMed, EMBASE, Cochrane, and Google Scholar for studies comparing outcomes of ViV-TMVR versus redo-SMVR in degenerated bioprosthetic mitral valves. We used a random-effects model to calculate odd ratios (ORs) with 95% confidence intervals (CIs). Outcomes included in-hospital, 30-day, 1-year, and 2-year mortality, stroke, bleeding, acute kidney injury, arrhythmias, permanent pacemaker insertion, and hospital length of stay (LOS). A total of 6 observational studies with 707 subjects were included. The median follow-up was 2.7 years. Despite their older age and greater co-morbidity burden, patients who underwent ViV-TMVR had a similar in-hospital mortality (OR 0.52, 95% CI 0.22 to 1.23, p = 0.14), 30-day mortality (OR 0.65, 95% CI 0.36 to 1.17, p = 0.15), 1-year mortality (OR 0.97, 95% CI 0.63 to 1.49, p = 0.89), and 2-year mortality (OR 1.17, 95% CI 0.65 to 2.13, p = 0.60) compared with redo-SMVR. ViV-TMVR was associated with significantly lower periprocedural complications, including stroke, bleeding, acute kidney injury, arrhythmias, and permanent pacemaker insertion, and shorter hospital LOS than redo-SMVR. In conclusion, ViV-TMVR was associated with better outcomes than redo-SMVR in patients with degenerated bioprosthetic mitral valves, including lower complication rates and shorter hospital LOS, with no significant difference in mortality rates. Large-scale randomized trials are needed to mitigate biases and confirm our findings.

First Page

98

Last Page

107

DOI

10.1016/j.amjcard.2022.11.043

Volume

189

Publication Date

2-2023

PubMed ID

36521415

Recommended Citation

Ismayl, M., Abbasi, M. A., Mostafa, M. R., Aboeata, A., Vora, A. N., Ben-Dor, I., Anavekar, N. S., & Goldsweig, A. M. (2023). Meta-Analysis Comparing Valve-in-Valve Transcatheter Mitral Valve Replacement Versus Redo Surgical Mitral Valve Replacement in Degenerated Bioprosthetic Mitral Valve. The American Journal of Cardiology, 189, 98-107. https://doi.org/10.1016/j.amjcard.2022.11.043