Transcatheter mitral valve-in-ring replacement was associated with higher 1-year all-cause mortality compared to valve-in-valve replacement (28.7% vs 12.6%; HR 2.70; 95% CI 1.34-5.43; P=0.005).
Observational (n=248)
Yes
Does TMVR for failed annuloplasty rings (ViR) compared to failed bioprosthetic valves (ViV) result in different procedural outcomes and mortality in high-risk patients?
TMVR for failed annuloplasty rings is associated with lower procedural success and higher 1-year mortality compared to TMVR for failed bioprosthetic valves.
Hazard Ratio: 2.7 (95% CI 1.34–5.43)
Absolute Event Rate: 28.7% vs 12.6%
p-value: p=0.005
BACKGROUND: Limited data exist regarding transcatheter mitral valve replacement (TMVR) for patients with failed mitral valve replacement and repair. OBJECTIVES: This study sought to evaluate the outcomes of TMVR in patients with failed mitral bioprosthetic valves (valve-in-valve ViV) and annuloplasty rings (valve-in-ring ViR). METHODS: From the TMVR multicenter registry, procedural and clinical outcomes of mitral ViV and ViR were compared according to Mitral Valve Academic Research Consortium criteria. RESULTS: A total of 248 patients with mean Society of Thoracic Surgeons score of 8.9 ± 6.8% underwent TMVR. Transseptal access and the balloon-expandable valve were used in 33.1% and 89.9%, respectively. Compared with 176 patients undergoing ViV, 72 patients undergoing ViR had lower left ventricular ejection fraction (45.6 ± 17.4% vs. 55.3 ± 11.1%; p < 0.001). Overall technical and device success rates were acceptable, at 92.3% and 85.5%, respectively. However, compared with the ViV group, the ViR group had lower technical success (83.3% vs. 96.0%; p = 0.001) due to more frequent second valve implantation (11.1% vs. 2.8%; p = 0.008), and lower device success (76.4% vs. 89.2%; p = 0.009) due to more frequent reintervention (16.7% vs. 7.4%; p = 0.03). Mean mitral valve gradients were similar between groups (6.4 ± 2.3 mm Hg vs. 5.8 ± 2.7 mm Hg; p = 0.17), whereas the ViR group had more frequent post-procedural mitral regurgitation moderate or higher (19.4% vs. 6.8%; p = 0.003). Furthermore, the ViR group had more frequent life-threatening bleeding (8.3% vs. 2.3%; p = 0.03), acute kidney injury (11.1% vs. 4.0%; p = 0.03), and subsequent lower procedural success (58.3% vs. 79.5%; p = 0.001). The 1-year all-cause mortality rate was significantly higher in the ViR group compared with the ViV group (28.7% vs. 12.6%; log-rank test, p = 0.01). On multivariable analysis, failed annuloplasty ring was independently associated with all-cause mortality (hazard ratio: 2.70; 95% confidence interval: 1.34 to 5.43; p = 0.005). CONCLUSIONS: The TMVR procedure provided acceptable outcomes in high-risk patients with degenerated bioprostheses or failed annuloplasty rings, but mitral ViR was associated with higher rates of procedural complications and mid-term mortality compared with mitral ViV.
Yoon et al. (2017) conducted an observational in Failed mitral bioprosthetic valves and annuloplasty rings (n=248). Transcatheter mitral valve replacement for failed annuloplasty rings (valve-in-ring) vs. Transcatheter mitral valve replacement for failed bioprosthetic valves (valve-in-valve) was evaluated on 1-year all-cause mortality (HR 2.70, 95% CI 1.34-5.43, p=0.005). Transcatheter mitral valve-in-ring replacement was associated with higher 1-year all-cause mortality compared to valve-in-valve replacement (28.7% vs 12.6%; HR 2.70; 95% CI 1.34-5.43; P=0.005).