3-Year Outcomes of Mitral Valve-in-Valve Therapy Using Balloon-Expandable Transcatheter Valves in the United States

BACKGROUND: Mitral valve-in-valve (MViV) is a safe and effective therapy for severe bioprosthetic mitral degeneration; however, longer-term outcomes are not well defined. OBJECTIVES: This study aimed to evaluate 3-year outcomes following MViV. METHODS: Outcomes of all-cause mortality, stroke, and reintervention were collected in patients undergoing transseptal MViV with the SAPIEN 3 valve family for failed surgical bioprostheses from June 2015 to March 2024 in the TVT (Transcatheter Valve Therapy) Registry, and Centers for Medicare and Medicaid Services data linkage was performed. Kaplan-Meier and Cox proportional hazards analysis was performed according to Society of Thoracic Surgeons (STS) score and procedure status. RESULTS: A total of 5,971 patients (age 72.9 ± 11.4 years, 57.9% [n = 3457 of 5,971] female) underwent MViV. Low (<4), intermediate (4-8), and high (>8) STS scores were present in 23.5% (n = 1,310 of 5,585), 35.1% (n = 1,960 of 5,585) and 41.5% (n = 2,315 of 5,585) of patients, respectively. Median follow-up duration was 377 days (Q1-Q3: 57-698 days). Mortality at 3 years was greatest in high STS score and nonelective procedures, while mortality was lowest in low STS score patients and elective procedures. Stroke rates at 3 years were comparable except between low and high STS groups. Mitral valve reintervention during 3 years of follow-up was uncommon in all groups. CONCLUSIONS: Three-year survival after MViV is highest in low STS scores and elective procedures, whereas survival was significantly lower in high STS scores and nonelective procedures. These findings emphasize the importance of early identification and treatment of patients who may benefit from MViV. Reintervention rates at 3 years are low regardless of STS score.