In-Hospital Outcomes and Predictors of Mortality for Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve-in-Valve Replacement

• Published in: The American journal of cardiology Vol. 176; pp. 89 - 95
• Main Authors: Gill, Jashan, Zahra, Farah, Retzer, Elizabeth
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2022; Elsevier Limited
• Subjects: Age; Apnea; Body mass; Body mass index; Body size; Cardiac arrhythmia; Cardiovascular disease; Chronic obstructive pulmonary disease; Cirrhosis; Complications; Confidence intervals; Coronary vessels; Demographics; Diabetes; Durability; Family income; Gender; Heart failure; Heart valves; Hospitalization; Hospitals; Kidney diseases; Liver cirrhosis; Malnutrition; Mitral valve; Morbidity; Mortality; Obesity; Patients; Prostheses; Sleep apnea; Sleep disorders; Statistical analysis; Trends; Vein & artery diseases; United States > US
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2022.04.023

Durability is a major limitation with bioprosthetic heart valves. For mitral valve prosthesis dysfunction, redo surgical mitral valve replacement (rSMVR) has been the mainstay of treatment; however, transcatheter mitral valve-in-valve replacement (mViV) has emerged as a viable alternative. Data comparing these procedures remains limited; therefore, we sought to compare the real-world in-hospital mortality, likelihood of adverse peri-operative outcomes, and predictors of mortality between rSMVR versus mViV using the National Inpatient Sample. During the study period, a weighted total of 1,890 patients (78%) underwent rSMVR, and 520 (22%) underwent mViV. After propensity matching, there were 310 patients in each cohort. There was no statistically significant difference in mortality with these procedures (odds ratio 1.53; 95% confidence interval 0.67 to 3.45; p = 0.31). rSMVR was associated with increased length of hospitalization (13 vs 7.5 days; p <0.001), increased medical costs ($324,124 vs $241,147; p <0.001), and increased peri-operative complications compared with mViV. Predictors of mortality unique to rSMVR were age >75 years, cirrhosis, sleep apnea, malnourishment/low body mass index, and obesity, signalizing greater suitability for mViV in these populations.