SURVIV
Transcatheter Mitral Valve-in-Valve vs Redo Mitral Valve Replacement for Failed Bioprosthetic Valves
Presented by Dimytri Siqueira — Instituto Dante Pazzanese
Subspecialty: Valvular
Published in ACC.26 Late-Breaking
Key Result
Transcatheter mVIV reduced death/disabling stroke by 77% vs redo surgery at 1 year. Zero CV deaths at 30 days with mVIV vs 12.5% with surgery. First randomized comparison of mVIV vs rMVR.
What did this trial find?
The SURVIV trial is the first randomized comparison of transcatheter mitral valve-in-valve (mVIV) vs redo surgical mitral valve replacement (rMVR) for failed bioprosthetic valves, conducted across 7 centers in Brazil with 150 patients. At 1 year, mVIV reduced the composite of death or disabling stroke by 77% (5.3% vs 20.8%, HR 0.23, p=0.005), with zero cardiovascular deaths at 30 days in the mVIV group vs 12.5% with surgery. Coverage is largely positive, with experts noting the results are encouraging but emphasizing the unique population (younger, rheumatic disease-predominant) and the need for long-term durability data and heart team-based individualization.
Why does this trial matter?
Mostly straightforward positive coverage with some meaningful nuance. The main debate centers on generalizability — the trial's Brazilian population with rheumatic heart disease differs significantly from US/European patients who tend to be older. Experts uniformly view the results as encouraging but emphasize the need for long-term durability data, heart team individualization, and caution about extrapolating to different populations. No real controversy about the primary findings.
Study Design
Investigator-initiated, randomized, controlled trial across 7 hospitals in Brazil (N=150)
Clinical Implications
Transcatheter valve-in-valve may offer a safer short-term alternative to redo surgery for failed mitral bioprostheses, especially in high-risk patients. Long-term durability data (10-year follow-up planned) is needed.
Abstract
The SURVIV study was an investigator-initiated, randomized trial across 7 referral CV hospitals in Brazil. It randomized 150 patients (mean age 58, 72% women) with severe symptomatic mitral bioprosthetic valve dysfunction 1:1 to transcatheter mitral valve-in-valve (mVIV) or surgical redo mitral valve replacement (rMVR). About 25% had prior re-do surgery, 70% had pulmonary hypertension, 50% had atrial fibrillation, and many had rheumatic heart disease. At 1 year, the primary endpoint of all-cause death or disabling stroke occurred in 5.3% of mVIV vs 20.8% of rMVR (HR 0.23, p=0.005), driven by early postoperative events. At 30 days, CV death was 0% vs 12.5%, acute kidney injury 0% vs 15.3% (p<0.001), and life-threatening/major bleeding 1.3% vs 11.1% (p=0.016).