Key result
Transapical transcatheter mitral valve replacement resulted in similar 30-day mortality (9.8% vs 15.2%) and 1-year mortality compared to conventional surgical redo mitral valve replacement in high-risk patients.
Why the study?
Redo surgical mitral valve patients often present with multiple comorbidities and high operative risk, making less invasive transcatheter options a needed alternative.
Does transapical transcatheter mitral valve replacement improve survival and reduce complications compared to surgical redo mitral valve replacement in high-risk patients with degenerated biological mitral valve prostheses or failed valve annuloplasty?
Observational (n=74)
No
Does transapical transcatheter mitral valve replacement improve survival and reduce complications compared to surgical redo mitral valve replacement in high-risk patients with degenerated biological mitral valve prostheses or failed valve annuloplasty?
Absolute Event Rate: 9.8% vs 15.2%
p-value: p=0.501
Transapical transcatheter mitral valve replacement is a feasible, non-inferior alternative to conventional surgical redo procedures in selected high-risk patients, offering similar survival and excellent hemodynamics.
BACKGROUND: Transcatheter methods have been rapidly evolving to provide an alternative less invasive therapeutic option, mainly because redo patients often present with multiple comorbidities and high operative risk. We sought to evaluate and compare our experience with transapical transcatheter mitral valve replacement (TA-TMVR) to conventional redo mitral valve replacement in patients presenting with degenerated biological mitral valve prostheses or failed valve annuloplasty. METHODS AND MATERIAL: Between March 2012 and November 2020, 74 consecutive high-risk patients underwent surgical redo mitral valve replacement (n = 33) or TA-TMVR (n = 41) at our institution. All patients presented with a history of a surgical mitral valve procedure. All transcatheter procedures were performed using the SAPIEN XT/3™ prostheses. Data collection was prospectively according to MVARC criteria. RESULTS: The mean logistic EuroSCORE-II of the whole cohort was 19.9±16.7%, and the median STS-score was 11.1±12.5%. The mean age in the SMVR group was 63.7±12.8 years and in the TMVR group 73.6±9.7 years. Patients undergoing TA-TMVR presented with significantly higher risk scores. Echocardiography at follow up showed no obstruction of the left ventricular outflow tract, no paravalvular leakage and excellent transvalvular gradients in both groups (3.9±1.2 mmHg and 4.2±0.8 mmHg in the surgical and transcatheter arm respectively). There was no difference in postoperative major adverse events between the groups with no strokes in the whole cohort. Both methods showed similar survival rates at one year and a 30-day mortality of 15.2% and 9.8% in SAVR and TMVR group, respectively. Despite using contrast dye in the transcatheter group, the rate of postoperative acute kidney failure was similar between the groups. CONCLUSION: Despite several contraindications for surgery, we showed the non-inferiority of TA-TMVR compared to conventional surgical redo procedures in high-risk patients. With its excellent hemodynamic and similar survival rate, TA-TMVR offers a feasible alternative to the conventional surgical redo procedure in selected patients.
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Zubarevich et al. (2021) conducted an observational in Degenerated biological mitral valve prostheses or failed valve annuloplasty (n=74). Transapical transcatheter mitral valve replacement (TA-TMVR) vs. Surgical redo mitral valve replacement (SMVR) was evaluated on 30-day mortality (p=0.501). Transapical transcatheter mitral valve replacement resulted in similar 30-day mortality (9.8% vs 15.2%) and 1-year mortality compared to conventional surgical redo mitral valve replacement in high-risk patients.
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