Meta-Analysis Comparing Valve-in-Valve Transcatheter Mitral Valve Replacement Versus Redo Surgical Mitral Valve Replacement in Degenerated Bioprosthetic Mitral Valve

• Published in: The American journal of cardiology Vol. 189; pp. 98 - 107
• Main Authors: Ismayl, Mahmoud, Abbasi, Muhannad Aboud, Mostafa, Mostafa Reda, Aboeata, Ahmed, Vora, Amit N., Ben-Dor, Itsik, Anavekar, Nandan S., Goldsweig, Andrew M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.02.2023; Elsevier Limited
• Subjects: Acute Kidney Injury; Aortic Valve - surgery; Bias; Bioprosthesis - adverse effects; Bleeding; Cardiac arrhythmia; Clinical outcomes; Clinical trials; Heart Valve Prosthesis - adverse effects; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Hospitals; Humans; Insertion; Kidneys; Meta-analysis; Mitral valve; Mitral Valve - surgery; Morbidity; Mortality; Observational studies; Pacemakers; Patients; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Prosthesis Failure - adverse effects; Reoperation; Risk Factors; Search engines; Stroke; Stroke - etiology; Systematic review; Treatment Outcome; United States > US
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2022.11.043

Valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) and redo surgical mitral valve replacement (redo-SMVR) are 2 treatment strategies for patients with bioprosthetic mitral valve dysfunction. We conducted a systematic review and meta-analysis to compare the outcomes of ViV-TMVR versus redo-SMVR. We searched PubMed, EMBASE, Cochrane, and Google Scholar for studies comparing outcomes of ViV-TMVR versus redo-SMVR in degenerated bioprosthetic mitral valves. We used a random-effects model to calculate odd ratios (ORs) with 95% confidence intervals (CIs). Outcomes included in-hospital, 30-day, 1-year, and 2-year mortality, stroke, bleeding, acute kidney injury, arrhythmias, permanent pacemaker insertion, and hospital length of stay (LOS). A total of 6 observational studies with 707 subjects were included. The median follow-up was 2.7 years. Despite their older age and greater co-morbidity burden, patients who underwent ViV-TMVR had a similar in-hospital mortality (OR 0.52, 95% CI 0.22 to 1.23, p = 0.14), 30-day mortality (OR 0.65, 95% CI 0.36 to 1.17, p = 0.15), 1-year mortality (OR 0.97, 95% CI 0.63 to 1.49, p = 0.89), and 2-year mortality (OR 1.17, 95% CI 0.65 to 2.13, p = 0.60) compared with redo-SMVR. ViV-TMVR was associated with significantly lower periprocedural complications, including stroke, bleeding, acute kidney injury, arrhythmias, and permanent pacemaker insertion, and shorter hospital LOS than redo-SMVR. In conclusion, ViV-TMVR was associated with better outcomes than redo-SMVR in patients with degenerated bioprosthetic mitral valves, including lower complication rates and shorter hospital LOS, with no significant difference in mortality rates. Large-scale randomized trials are needed to mitigate biases and confirm our findings. [Display omitted]