Transcatheter mitral valve implantation had similar short-term outcomes to repeated surgery but was associated with significantly worse survival after four years (log-rank = 0.047).
Cohort (n=41)
No
Does transcatheter valve-in-valve implantation in the mitral position improve survival compared to repeated mitral valve surgery in patients with prior ring or bioprosthetic implantation?
While TMVI and RMVS have similar short-term outcomes for prior mitral bioprosthesis or ring failure, TMVI is associated with significantly lower survival after four years.
Absolute Event Rate: 4.79% vs 8%
p-value: p=0.087
Background: In recent years, the use of transcatheter valve-in-valve implantation in the mitral position (TMVI) for the treatment of mitral valve pathology following ring or bioprosthetic implantation has emerged as a less invasive option in comparison to repeated mitral valve surgery (RMVS). We aimed to compare the early and mid-term results of these two strategies. Method: We retrospectively analyzed all patients who underwent a mitral intervention in our institution between 2005 and 2022. Applying the exclusion criteria, 41 subjects were analyzed: 23 underwent RMVS, while 18 underwent a TMVI. The time-dependency treatment effect was approached using a landmark analysis, applying the Kaplan–Meier analysis at different time points. Results: The two study groups were comparable in terms of age (p = 0.18), gender (p = 0.78), body surface area (p = 0.33), and EuroSCORE II (p = 0.06). No patients died perioperatively or had a stroke. Two patients in each group died within the first 30 days following the procedure (RMVS 8.3% vs. TMVI 11.1%; p = 0.75). Eighteen patients had died at follow-up; two underwent re-intervention on their mitral valve (one in each group). The mean survival was not statistically different between groups (RMVS 8 ± 1.1 years, 95% CI 5.8–10.2, vs. TMVI 4.79 ± 0.82 years, 95% CI 3.1–6.4; log-rank = 0.087). A landmark analysis of survival after four years showed significantly worse survival for patients in the TMVI group in comparison with those treated surgically (log-rank = 0.047). Conclusions: TMVI and RMVS are both effective strategies with similar short-term outcomes. However, patients in the TMVI group showed a significantly lower survival rate after four years.
Pollari et al. (Sun,) conducted a cohort in Mitral valve pathology following ring or bioprosthetic implantation (n=41). Transcatheter valve-in-valve implantation in the mitral position (TMVI) vs. Repeated mitral valve surgery (RMVS) was evaluated on Mean survival (years) (p=0.087). Transcatheter mitral valve implantation had similar short-term outcomes to repeated surgery but was associated with significantly worse survival after four years (log-rank = 0.047).
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