Valve-in-Valve Transcatheter Mitral Valve Replacement Versus Redo Surgical Mitral Valve Replacement: Meta-Analysis of Early and Late Outcomes.

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Failed bioprosthetic mitral valves (n=15941). Intervention: Valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) vs. Redo surgical mitral valve replacement (redo-SMVR). Primary outcome: In-hospital mortality (RR 0.72, 95% CI 0.57-0.90, p=0.004).

Michel Pompeu Sá; G Rezende Neves; Leo Consoli; Asad Iqbal; Leonardo Dexheimer; David Abraham Batista da Hora; Thiago Camarotti; Xander Jacquemyn; Federico Napoli; Antonio Polanco; Nicolas Brozzi; Jose L Navia

doi:10.1161/jaha.126.050299

May 3, 2026

Valve-in-Valve Transcatheter Mitral Valve Replacement Versus Redo Surgical Mitral Valve Replacement: Meta-Analysis of Early and Late Outcomes.

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Key result

Valve-in-valve transcatheter mitral valve replacement reduced in-hospital mortality (RR 0.72) but was associated with higher all-cause mortality after 6 months (HR 1.47) compared to redo surgery.

Figures

Graphical abstract published by the journal — Graphical abstract · Published by the journal · CC BY-NC-ND

Why the study?

Bioprosthetic mitral valve degeneration is traditionally treated with redo surgical mitral valve replacement, but valve-in-valve transcatheter mitral valve replacement offers a less invasive alternative.

Does ViV-TMVR reduce mortality and complications compared to redo-SMVR in patients with degenerated bioprosthetic mitral valves?

Study Design

Type

Meta-Analysis (n=15,941)

Structured PICO

Does ViV-TMVR reduce mortality and complications compared to redo-SMVR in patients with degenerated bioprosthetic mitral valves?

P

Population

15,941 patients with degenerated bioprosthetic mitral valves from 13 observational studies comparing valve-in-valve transcatheter mitral valve replacement versus redo surgical mitral valve replacement.

I

Intervention

Valve-in-valve transcatheter mitral valve replacement (ViV-TMVR)

C

Comparator

Redo surgical mitral valve replacement (redo-SMVR)

O

Outcome

Early (in-hospital/30-day) mortality and late all-cause mortality in follow-up (up to 5 years)hard clinical

Main Result

Relative Risk: 0.72 (95% CI 0.57–0.9)

p-value: p=0.004

ViV-TMVR offers a lower up-front risk of mortality and peri-procedural complications compared to redo-SMVR, but this early survival benefit does not persist, with redo-SMVR yielding better survival beyond 6 months.

Limitations

No randomized trials were included; all studies were observational and retrospective, carrying a potential for selection bias.
Lack of patient-level covariates preventing propensity matching or covariate adjustments.
Key unmeasured confounders expected to bias the late-mortality HR include frailty, functional status, and operator experience.
Potential unintentional overlap of cases in different studies due to use of national databases.
Analyses of rare events were limited by zero-event data in the comparator arm, requiring constant continuity correction.
All included studies were observational and retrospective, lacking randomized data.
High risk of selection bias and confounding, as ViV-TMVR patients were generally older with more comorbidities.
Inability to perform patient-level risk adjustment or propensity matching due to lack of individual covariate data.
Zero-event data for rare events requiring continuity corrections that may bias relative risk estimates.

Discussion

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Implication

ViV-TMVR may reduce early mortality in high-risk patients; leaves open long-term survival benefit versus redo surgery pending randomized trials.

Abstract

BACKGROUND: Bioprosthetic mitral valve degeneration is traditionally treated with redo surgical mitral valve replacement (redo-SMVR), but valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) offers a less invasive alternative. METHODS: Systematic review and meta-analysis of studies comparing ViV-TMVR and redo-SMVR. PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane databases (inception to September 2025) were searched. Meta-analyses were conducted with random-effects models to assess patient-relevant outcomes; Kaplan-Meier-derived time-to-event data were pooled to assess late outcomes. RESULTS: <0.001). CONCLUSIONS: In patients amenable to ViV-TMVR, this procedure shows a lower initial risk of death and complications, but higher mortality after 6 months in comparison with redo-SMVR. These findings highlight the importance of striking a balance between upfront surgical risk and estimated life expectancy when selecting interventions.

Cite This Study

Sá et al. (2026) conducted a meta-analysis in Failed bioprosthetic mitral valves (n=15,941). Valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) vs. Redo surgical mitral valve replacement (redo-SMVR) was evaluated on In-hospital mortality (RR 0.72, 95% CI 0.57-0.90, p=0.004). Valve-in-valve transcatheter mitral valve replacement reduced in-hospital mortality (RR 0.72) but was associated with higher all-cause mortality after 6 months (HR 1.47) compared to redo surgery.

synapsesocial.com/papers/69f9890415588823dae17df3 https://doi.org/10.1161/jaha.126.050299

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Valve-in-Valve Transcatheter Mitral Valve Replacement Versus Redo Surgical Mitral Valve Replacement: Meta-Analysis of Early and Late Outcomes.

Figures

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Abstract

Cite This Study

Valve-in-Valve Transcatheter Mitral Valve Replacement Versus Redo Surgical Mitral Valve Replacement: Meta-Analysis of Early and Late Outcomes.

Figures

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Abstract

Cite This Study

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