What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Degenerated mitral valve bioprostheses, failure of mitral valvuloplasty, and severe mitral annulus calcification (n=2875). Intervention: Transcatheter mitral valve-in-valve (TMViV) vs. Transcatheter mitral valve-in-ring (TMViR). Primary outcome: All-cause mortality within 30 days (OR 0.70, 95% CI 0.50-0.99, p=0.04).

October 10, 2021Open Access

Transcatheter mitral valve replacement for degenerated mitral valve bioprostheses, failure of mitral valvuloplasty and native valve with severe mitral annulus calcification: a systematic review and meta-analysis

Key Result

Transcatheter mitral valve-in-valve (TMViV) significantly reduced all-cause mortality within 30 days compared to transcatheter mitral valve-in-ring (TMViR) (OR 0.70).

Study Design

Type

Meta-Analysis (n=2,875)

Structured PICO

Does transcatheter mitral valve replacement have different safety and efficacy profiles when used for valve-in-valve, valve-in-ring, or valve-in-MAC procedures?

Population

2,875 patients with degenerated mitral valve bioprostheses, failed annuloplasty rings, or severe mitral annular calcification undergoing transcatheter mitral valve replacement, followed for at least 30 days.

Intervention

Transcatheter mitral valve replacement (TMVR) for ViV, ViR, and ViMAC

Comparator

Comparison between ViV, ViR, and ViMAC groups

Outcome

All-cause mortality within 30 days, bleeding, and left ventricular outflow tract (LVOT) obstructionhard clinical

Transcatheter mitral valve-in-valve and valve-in-ring procedures show good applicability, with valve-in-valve demonstrating lower 30-day mortality and fewer complications than valve-in-ring.

Main Result

Odds Ratio: 0.7 (95% CI 0.5–0.99)

p-value: p=0.04

Limitations

Few studies available for analysis, especially for TMViMAC
Only early results (30 days) were obtained due to follow-up time differences
Some baselines were incomparable
Lack of evidence for a direct comparison between TMViV and TMViMAC

Abstract

BACKGROUND: Although transcatheter technology has achieved some success in the field of mitral valves, the feasibility of applying it to patients with degenerated mitral valve bioprostheses (valve-in-valve, ViV), failure of mitral valvuloplasty (valve-in-ring, ViR) and serious mitral annulus calcification (vale-in-MAC, ViMAC) has not been effectively evaluated. METHODS: By searching published literature before December 5, 2020 in four databases, we found all the literature related to the evaluation of feasibility assessment of TMViV, TMViR and TMViMAC. Outcomes focused on all-cause mortality within 30 days, bleeding and LVOT obstruction. RESULTS: A total of six studies were included, and all of them were followed up for at least 30 days. After analysis of the ViV-ViR group, we obtained the following results: the all-cause mortality within 30 days of the ViV group was lower than that of the ViR group. Life-threatening or fatal bleeding was more likely to occur in the ViR group after surgery. At the same time, the ViR group was more prone to left ventricular outflow tract obstruction. However, in the ViMAC-ViR group, only the all-cause mortality within 30 days and stroke were statistically significant. In the indirect comparison, we found that TMViV had the best applicability, followed by TMViR. There were few TMViMAC available for analysis, and it requires further studies to improve the accuracy of the results. CONCLUSION: TMViV and TMViR had good applicability and could benefit patients who underwent repeat valve surgery. The feasibility of TMViMAC needs to be further explored and improved.

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