Treatment of Failed Mitral Valve Bioprostheses or Repairs: Transcatheter Mitral Valve-in-Valve/Valve-in-Ring Versus Redo Surgical Mitral Valve Replacement

Q: What are the key findings of this study?

Transcatheter mitral ViV/ViR had lower 30-day device success than redo-MVR (40.0% vs 86.7%, p=0.02) and comparable 30-day mortality (6.7% vs 0%, p=1.00).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Failed mitral valve bioprostheses or repairs (n=30). Intervention: Transcatheter mitral valve-in-valve (ViV) or valve-in-ring (ViR) vs. Redo surgical mitral valve replacement (redo-MVR). Primary outcome: 30-day device success (MVARC criteria) (p=0.02).

Q: What does this research mean for the field?

In patients with failed mitral valve bioprostheses or repairs, 30-day mortality is similarly low between transcatheter valve-in-valve/valve-in-ring and redo surgical replacement, but redo surgery achieves higher 30-day device success due to lower postoperative gradients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jacqueline Kruse; Eissa Alaj; Nihal Wilde; Hossien Alirezaei; Marwan Hamiko; Sebastian Zimmer; Marcel Weber; Enzo Lüsebrink; Miriam Silaschi; Farhad Bakhtiary

doi:10.3390/jcm15218423

October 29, 2026Journal of Clinical MedicineOpen Access

Treatment of Failed Mitral Valve Bioprostheses or Repairs: Transcatheter Mitral Valve-in-Valve/Valve-in-Ring Versus Redo Surgical Mitral Valve Replacement

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Key result

Transcatheter mitral ViV/ViR yields lower 30-day device success than redo-MVR, with comparable mortality.

P=0.02
n=30

Why the study?

Transcatheter mitral valve-in-valve (ViV) and valve-in-ring (ViR) procedures have emerged as alternatives for failed mitral bioprostheses or ring annuloplasty, while redo surgical mitral valve replacement (redo-MVR) remains standard therapy despite perceived higher procedural risk. This study aimed to descriptively compare short- and long-term outcomes of ViV/ViR and redo-MVR.

Does transcatheter mitral valve-in-valve or valve-in-ring (ViV/ViR) improve 30-day mortality and MVARC-defined device success compared to redo surgical mitral valve replacement in patients older than 60 years with failed mitral valve bioprostheses or repairs?

Key Points

To descriptively compare short- and long-term clinical and procedural outcomes between transcatheter valve-in-valve or valve-in-ring procedures and redo surgical mitral valve replacement in failed repairs or bioprostheses.
Retrospective single-center study including patients older than 60 years treated for failed mitral bioprostheses or repairs between 2000 and 2022 (N=30).
Compared patients receiving transcatheter valve-in-valve or valve-in-ring (n=15, treated 2008–2022) against redo surgical mitral valve replacement (n=15).
Evaluated technical, device, and procedural success based on standardized Mitral Valve Academic Research Consortium (MVARC) criteria.
Thirty-day mortality did not differ significantly between groups (6.7% [1/15] for transcatheter vs. 0% [0/15] for redo surgery, p = 1.00), despite transcatheter patients being significantly older (76.9 ± 5.8 vs. 68.0 ± 8.4 years, p < 0.001).
Device success at 30 days was significantly higher after redo surgical replacement than transcatheter procedures (86.7% vs. 40.0%, p = 0.02).
Transcatheter patients had smaller implanted valve sizes (28.2 ± 1.4 vs. 29.5 ± 1.8 mm, p = 0.03) and higher pre-procedural and discharge mitral valve gradients, while neurological events were rare in both groups.

Study Design

Type

Cohort (n=30)

Multicenter

No

Structured PICO

Does transcatheter mitral valve-in-valve or valve-in-ring (ViV/ViR) improve 30-day mortality and MVARC-defined device success compared to redo surgical mitral valve replacement in patients older than 60 years with failed mitral valve bioprostheses or repairs?

P

Population

30 patients older than 60 years with failed mitral valve bioprostheses or repairs treated with transcatheter ViV/ViR (mean age 76.9 years) or redo surgical MVR (mean age 68.0 years) between 2000 and 2022.

E

Exposure

Transcatheter mitral valve-in-valve (ViV) or valve-in-ring (ViR) procedure (n=15)

C

Comparator

Redo surgical mitral valve replacement (redo-MVR) (n=15)

O

Outcome

Short- and long-term outcomes including 30-day mortality and technical, device, and procedural success at 30 days defined according to Mitral Valve Academic Research Consortium (MVARC) criteriacomposite

Main Result

Absolute Event Rate: 40% vs 86.7%

p-value: p=0.02

Limitations

Small sample size
Retrospective, single-center cohort
Substantial baseline differences between groups (e.g., age)
Findings are descriptive and hypothesis-generating and do not constitute evidence of comparative treatment effectiveness
Small sample size (n = 30)
Retrospective design
Single-center cohort
Substantial baseline differences between groups (e.g., age, prior prosthesis vs. ring)
Descriptive and hypothesis-generating nature that does not constitute evidence of comparative treatment effectiveness

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Implication

In a small retrospective cohort of patients over 60 with failed mitral bioprostheses or repairs, both transcatheter ViV/ViR and redo surgical MVR showed low 30-day mortality, though redo-MVR achieved higher 30-day device success largely due to lower postoperative gradients.

Abstract

Background/Objectives: Transcatheter mitral valve-in-valve (ViV) and valve-in-ring (ViR) procedures have emerged as alternative treatment options for failed mitral valves following prior bioprosthetic replacement or ring annuloplasty. However, redo surgical mitral valve replacement (redo-MVR) remains the standard therapy despite its perceived higher procedural risk. This study aimed to descriptively compare short- and long-term outcomes of ViV/ViR and redo-MVR. Methods: We retrospectively included patients older than 60 years who underwent treatment of failed mitral valve bioprostheses or repairs between 2000 and 2022 (n = 30; ViV/ViR cohort: 2008–2022). Patients treated with ViV/ViR (n = 15) were compared with those undergoing redo-MVR (n = 15). Endpoints were reported according to Mitral Valve Academic Research Consortium (MVARC) criteria. Technical, device, and procedural success were defined according to the MVARC criteria and applied identically to both groups. Owing to the small sample size and substantial baseline differences, this study is descriptive and hypothesis-generating. Results: Patients in the ViV/ViR group were significantly older than redo-MVR patients (76.9 ± 5.8 vs. 68.0 ± 8.4 years, p < 0.001). EuroSCORE II did not differ significantly between groups. Thirty-day mortality was comparable, with one death in the ViV/ViR group and none after redo-MVR (6.7% vs. 0%, p = 1.00). Device success at 30 days was significantly higher after redo-MVR compared with ViV/ViR (86.7% vs. 40.0%, p = 0.02). Neurological events were rare and similar between groups. Degenerated bioprostheses were more frequent in the ViV/ViR group (86.6%), whereas prior annuloplasty ring implantation predominated in redo-MVR patients (80.0%, p < 0.01). Pre-procedural and discharge mitral valve gradients were higher in ViV/ViR patients. Implanted valve size was smaller in the ViV/ViR cohort (28.2 ± 1.4 vs. 29.5 ± 1.8 mm, p = 0.03). Conclusions: In this small, retrospective, single-center cohort with substantial baseline differences (e.g., age), 30-day mortality was low in both groups. Device success was higher after redo-MVR, mainly because of higher postoperative gradients after ViV/ViR. These findings are descriptive and hypothesis-generating and do not constitute evidence of comparative treatment effectiveness. Both approaches may be considered complementary options guided by a multidisciplinary heart team.

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Cite This Study

Kruse et al. (2026) conducted a cohort in Failed mitral valve bioprostheses or repairs (n=30). Transcatheter mitral valve-in-valve (ViV) or valve-in-ring (ViR) vs. Redo surgical mitral valve replacement (redo-MVR) was evaluated on 30-day device success (MVARC criteria) (p=0.02). Transcatheter mitral ViV/ViR had lower 30-day device success than redo-MVR (40.0% vs 86.7%, p=0.02) and comparable 30-day mortality (6.7% vs 0%, p=1.00).

synapsesocial.com/papers/6ae585ee4c46c197bbab591f https://doi.org/10.3390/jcm15218423

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Treatment of Failed Mitral Valve Bioprostheses or Repairs: Transcatheter Mitral Valve-in-Valve/Valve-in-Ring Versus Redo Surgical Mitral Valve Replacement

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Treatment of Failed Mitral Valve Bioprostheses or Repairs: Transcatheter Mitral Valve-in-Valve/Valve-in-Ring Versus Redo Surgical Mitral Valve Replacement

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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