Affiliation:
1. Department of Cardiovascular Surgery Mount Sinai Hospital New York NY
2. Division of Cardiac Surgery Brigham and Women's Hospital Boston MA
3. Minneapolis Heart Institute Foundation Minneapolis MN
4. Brigham and Women's Heart & Vascular CenterHarvard Medical School Boston MA
Abstract
Abstract
Bioprosthetic mitral structural valve degeneration and failed mitral valve repair (MVr) have traditionally been treated with reoperative mitral valve surgery. Transcatheter mitral valve‐in‐valve (MVIV) and valve‐in‐ring (MVIR) replacement are now feasible, but data comparing these approaches are lacking. We sought to compare the outcomes of (1) reoperative mitral valve replacement (redo‐MVR) and MVIV for structural valve degeneration, and (2) reoperative mitral valve repair (redo‐MVr) or MVR and MVIR for failed MVr. A literature search of PubMed, Embase, and the Cochrane Library was conducted up to July 31, 2020. Thirty‐two studies involving 25 832 patients were included. Redo‐MVR was required in ≈35% of patients after index surgery at 10 years, with 5% to 15% 30‐day mortality. MVIV resulted in >95% procedural success with 30‐day and 1‐year mortality of 0% to 8% and 11% to 16%, respectively. Recognized complications included left ventricular outflow tract obstruction (0%–6%), valve migration (0%–9%), and residual regurgitation (0%–6%). Comparisons of redo‐MVR and MVIV showed no statistically significant differences in mortality (11.3% versus 11.9% at 1 year,
P
=0.92), albeit higher rates of major bleeding and arrhythmias with redo‐MVR. MVIR resulted in 0% to 34% mortality at 1 year, whereas both redo‐MVr and MVR for failed repairs were performed with minimal mortality and durable long‐term results. MVIV is therefore a viable alternative to redo‐MVR for structural valve degeneration, whereas redo‐MVr or redo‐MVR is preferred for failed MVr given the suboptimal results with MVIR. However, not all patients will be candidates for MVIV/MVIR because anatomical restrictions may preclude transcatheter options from adequately addressing the underlying pathology.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
24 articles.
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