What question did this study set out to answer?

This study aims to compare the safety and outcomes of transcatheter mitral valve replacement and redo surgical mitral valve replacement in patients with failed bioprostheses.

April 23, 2026Open Access

Transcatheter valve-in-valve implantation versus redo surgical mitral valve replacement in patients with failed mitral bioprostheses

Key Result

ViV-TMVR is associated with lower odds of in-hospital mortality, complications, and resource utilization compared to redo surgical mitral valve replacement for failed bioprostheses.

Key Points

This study aims to compare the safety and outcomes of transcatheter mitral valve replacement and redo surgical mitral valve replacement in patients with failed bioprostheses.
Utilized the Nationwide Readmission Database from 2015 to 2019 for analysis.
Conducted propensity-matched analysis to determine adjusted odds ratios for major outcomes at index hospitalization, 30 days, and 6 months.
Analyzed data from a total of 3,691 patients, of which 24.2% underwent ViV-TMVR and 75.8% underwent redo-SMVR.
In-hospital all-cause mortality was significantly lower in ViV-TMVR (2.6%) than in redo-SMVR (7.3%).
30-day all-cause mortality was comparable between both groups (aOR 1.01, 95% CI: 0.40-2.55).
The utilization of ViV-TMVR increased significantly from 5.2% to 36.8% during the study period (ptrend<0.01).

Structured PICO

Does transcatheter valve-in-valve implantation reduce in-hospital mortality and complications compared to redo surgical mitral valve replacement in patients with failed mitral bioprostheses?

Population

Patients with failed mitral bioprostheses

Intervention

Transcatheter valve-in-valve implantation (ViV-TMVR)

Comparator

Redo surgical mitral valve replacement

Outcome

In-hospital mortality, complications, and resource utilisationhard clinical

ViV-TMVR is associated with lower in-hospital mortality and complications compared to redo surgical mitral valve replacement for failed bioprostheses.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

BACKGROUND: Data on the safety of valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) compared with redo surgical mitral valve replacement (SMVR) in patients with a history of bioprosthetic mitral valve (MV) remain limited. AIMS: We aimed to evaluate the in-hospital, 30-day and 6-month readmission outcomes of ViV-TMVR compared with redo-SMVR in a real-world cohort. METHODS: The Nationwide Readmission Database was utilised, analysing data from 2015 to 2019. To determine the adjusted odds ratio (aOR), we used the propensity-matched analysis for major outcomes at index hospitalisation, 30 days, and 6 months during the episode of readmission. RESULTS: A total of 3, 691 patients were included, of these, 24. 2% underwent ViV-TMVR and 75. 8% underwent redo-SMVR. Patients undergoing ViV-TMVR were older with higher rates of comorbidities. The mean length of stay (15 days vs 4 days) and cost of hospitalisation (76, 558 vs 46, 743) were significantly higher for redo-SMVR. The rate of in-hospital all-cause mortality was also significantly lower in ViV-TMVR (2. 6% vs 7. 3%). By contrast, 30-day all-cause mortality during the episode of readmission (aOR 1. 01, 95% confidence interval CI: 0. 40-2. 55) and all-cause readmission rates (aOR 0. 82, 95% CI: 0. 66-1. 02) were similar between both groups. The incidence of all-cause readmissions at 6 months (aOR 0. 83, 95% CI: 0. 65-1. 05) and all-cause mortality during the episode of readmission at 6 months (aOR 1. 84, 95% CI: 0. 54-6. 36) were also comparable. The utilisation of the ViV-TMVR procedure increased significantly during our study duration, from 5. 2% to 36. 8%, (ptrend<0. 01). CONCLUSIONS: ViV-TMVR is associated with lower odds of in-hospital mortality, complications, and resource utilisation. The all-cause readmissions and 30-day and 6-month mortality during the episode of readmissions were comparable between both groups.