Comparison of Clinical and Echocardiographic Outcomes After Surgical Redo Mitral Valve Replacement and Transcatheter Mitral Valve-in-Valve Therapy

Kamioka, Norihiko; Babaliaros, Vasilis; Morse, Michael A.; Frisoli, Tiberio; Lerakis, Stamatios; Iturbe, Jose Miguel; Binongo, José; Corrigan, Frank; Yousef, Altayyeb; Gleason, Patrick; Wells, John A.; Caughron, Hope; Dong, Andy; Rodríguez, Evelio; Leshnower, Bradley G.; O’Neill, William W.; Paone, Gaetano; Eng, Marvin H.; Guyton, Robert A.; Block, Peter C.; Greenbaum, Adam

doi:10.1016/j.jcin.2018.03.011

Cited by 84 publications

(76 citation statements)

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“…Such degeneration is often characterized by leaflet thickening, restricted leaflet motion, or flail leaflet and can present as prosthetic mitral stenosis, regurgitation, or a mixed phenotype. In the setting of elevated surgical risk and need for intervention, transseptal transcatheter mitral valve‐in‐ring/−valve replacement (TMVR) has offered a convincing alternative with relatively reduced morbidity, improved recovery, and shorter hospitalizations in selected patients with prosthetic mitral valve stenosis and/or regurgitation …”

Section: Introductionmentioning

confidence: 99%

“…In the setting of elevated surgical risk and need for intervention, transseptal transcatheter mitral valve-in-ring/−valve replacement (TMVR) has offered a convincing alternative with relatively reduced morbidity, improved recovery, and shorter hospitalizations in selected patients with prosthetic mitral valve stenosis and/or regurgitation. [2][3][4][5][6] Although TMVR interventions have become increasingly commonplace, the potentially differing responses of unique patient populations to TMVR have not been elucidated fully. To this end, this study aimed to assess and compare the immediate hemodynamic changes effected by mitral TMVR and the attendant clinical outcomes in patients with mitral valve prostheses that had developed principally either stenotic or regurgitant prosthetic degeneration.…”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic and clinical response to transseptal mitral valve‐in‐valve and valve‐in‐ring

Lloyd

Joseph

Cabalka

et al. 2019

Cathet Cardio Intervent

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Objective To understand the clinical and hemodynamic response of patients with stenotic versus regurgitant prosthetic mitral valve degeneration to transseptal transcatheter mitral valve‐in‐ring/‐valve replacement (TMVR). Background Patients with prosthetic mitral valve repair/replacement failure frequently present high‐risk surgical challenges. TMVR has been employed as an alternative to surgery. Methods Forty‐four patients with stenotic/regurgitant degeneration of prior prosthetic mitral annuloplasty and replacement (38) underwent mitral TMVR. Clinical, echocardiographic, and invasive hemodynamic monitoring was conducted at baseline and follow‐up. Results Relative to patients with regurgitant degeneration (28), patients with stenotic degeneration had baseline higher mitral valve gradients (12 ± 4 vs. 7 ± 3 mmHg, p < 0.01) and smaller areas (1.0 ± 0.4 vs. 1.5 ± 0.4 cm2, p = 0.01). TMVR yielded significant reduction in left atrial v‐wave pressures in stenotic and regurgitant cohorts (−7 ± 11, p = 0.03, and −11 ± 12 mmHg, p < 0.01, respectively) and significant, sustained symptomatic improvement. Intracardiac pressures overall, including left ventricular end diastolic pressures, remained elevated. Conclusion Despite baseline differences in valvular disease, TMVR leads to significant hemodynamic and clinical improvement in both stenotic and regurgitant prosthetic mitral valve disease. In both cohorts, TMVR reduced intracardiac pressures to similar postprocedural levels, but pressures remained supranormal. This outcome suggests a multifactorial process defines the pathophysiology of patients undergoing TMVR, including contributions from prosthetic degeneration, changes in left atrial compliance, and diastolic dysfunction, and highlights the need to consider such factors in patient evaluation and treatment.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hemodynamic and clinical response to transseptal mitral valve‐in‐valve and valve‐in‐ring

Lloyd

Joseph

Cabalka

et al. 2019

Cathet Cardio Intervent

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Section: Resultsmentioning

confidence: 99%

“…Of 270 potentially relevant articles screened initially, 17 eligible studies including a total of 1017 patients undergoing VIV/VIR‐TMVI were identified (Table ). Only two small‐size study compared VIV‐TMVI with redo MVS, and one of them using a propensity‐score analysis . Eleven studies analyzed exclusive VIV‐TMVI patients, only one study examined exclusive VIR‐TMVI patients, two studies investigated combined VIV/VIR‐TMVI patients, and three studies researched VIV‐TMVI and VIR‐TMVI patients separately.…”

Section: Resultsmentioning

confidence: 99%

“…Transcatheter mitral valve implantation (TMVI) by the off‐label use of transcatheter aortic valve implantation (TAVI) devices has developed and refined on safe and effective management of the variety of pathologies after MVS . To the best of our knowledge, however, no randomized controlled trial (RCT) and only two small‐size comparative study of TMVI for deteriorated bioprosthetic valves (valve‐in‐valve [VIV]‐TMVI) and/or failed annuloplasty rings (valve‐in‐ring [VIR]‐TMVI) versus redo MVS have been conducted to date. Thus, it remains unclear whether VIV/VIR‐TMVI reduces mortality as compared with redo MVS.…”

Section: Introductionmentioning

confidence: 99%

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A meta‐analysis of valve‐in‐valve and valve‐in‐ring transcatheter mitral valve implantation

Takagi

Hari

Kawai

et al. 2018

J Interven Cardiology

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Objectives: We performed a meta-analysis of transcatheter mitral valve implantation (TMVI) for deteriorated bioprosthetic valves (valve-in-valve [VIV]-TMVI) and/or failed annuloplasty rings (valve-in-ring [VIR]-TMVI), comparing observed early (30-day) mortality with predicted operative mortality. Background: It remains unclear whether VIV/VIR-TMVI reduces mortality as compared with redo MVS. Methods: MEDLINE and EMBASE were searched current through 24 July 2018 using Web-based search engines (PubMed and OVID) to identify studies including ≥10 patients undergoing VIV/VIR-TMVI. For each study, data regarding observed 30-day mortality and predicted operative mortality (Society of Thoracic Surgeons Predicted Risk of Mortality [STS-PROM]) were used to generate risk ratios (RRs) and 95% confidence intervals (CIs). Study-specific estimates were combined using the inverse variance-weighted average of logarithmic RRs in the random-effects model. Onegroup meta-analyses of 30-day/late (including 30-day) mortality rates were also performed in the random-effects model.Results: Of 270 potentially relevant articles screened initially, 17 eligible studies including a total of 1017 patients undergoing VIV/VIR-TMVI were identified. In all but four studies, the STS-PROM was available and varied from 7.7% to 22.0% (weighted mean, 11.5%). Pooled analyses of all VIV/VIR-TMVI studies demonstrated the 30-day mortality rate of 5.4% (95%CI, 4.0-6.8%), the midterm (1-to 5-year) mortality rate of 13.7% (95%CI, 9.0-18.5%), and significantly lower observed 30-day mortality than predicted operative mortality (RR, 0.67; 95%CI, 0.49-0.91; P = 0.01).Conclusions: VIV/VIR-TMVI brought about relatively low early and midterm (1-to 5year) mortality, and observed 30-day mortality was significantly lower than predicted operative mortality. K E Y W O R D S meta-analysis, mortality, transcatheter mitral valve implantation, valve-in-ring, valve-in-valve J Interv Cardiol. 2018;31:899-906.wileyonlinelibrary.com/journal/joic

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Transcatheter Mitral Valve-in-Valve—A Plausible Option but Questions Remain

Asgar

2020

JAMA Cardiol

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Structural valve deterioration is a long-term complication of valve replacement and one that occurs more frequently with biologic valves. Reoperation for structural valve deterioration of a mitral prosthesis is associated with increased mortality, postoperative complications, and resource use. 1 Transcatheter valve-invalve replacement has shown promise in previously published series of fewer than 100 patients. It is therefore very interesting to review the data on outcomes of transcatheter mitral valve-in-valve (MViV) in high-risk patients from the Society of Thoracic Surgeons/American College of Cardiology TVT Registry published in this issue of JAMA Cardiology by Whisenant et al. 2 This retrospective study comprised 1529 patients undergoing transcatheter MViV from 2015 to 2019 at more than 300 centers in the US with the Edwards Lifesciences SAPIEN 3 transcatheter heart valve. The primary end points of interest were 1-year all-cause mortality and procedural technical success. This was defined at exit from the hybrid suite as patient alive with successful access, delivery and retrieval of the device delivery system, successful deployment and correct position of the first intended device, and freedom from emergency surgery or reintervention associated with the device or access procedure. 3 The mean patient age was 73 years and the predominant cause of valve failure was mitral stenosis in 55%. Patients were predominantly intermediate and high surgical risk according to the Society of Thoracic Surgeons risk score, with prior coronary artery bypass graft surgery in 34.5% and atrial fibrillation in 71%. Left ventricular ejection fraction was preserved overall and the mean mitral gradient prior to intervention was 12.7 mm Hg. More than 50% of patients had concomitant moderate to severe tricuspid regurgitation (TR).Transcatheter MViV was performed via transseptal access for most patients (86.7%), with a procedural technical success of 96.8%. Procedural complications were rare, with device embolization and conversion to open surgery occurring in 0.3% and 0.9%, respectively. In-hospital all-cause mortality was 4% in this high-risk population and 0.9% developed left ventricular outflow tract obstruction, of whom half died at follow-up. Transseptal access was associated with lower mortality than the transapical approach. One-year all-cause mortality in this cohort was 16.7%. However, 1-year follow-up was not complete in 54% of patients, with 493 patients (32%) not yet due for their follow-up and 314 patients (21%) with data unavailable for unspecified reasons. Quality of life was significantly improved for most patients at 30 days as measured by

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Comparison of Clinical and Echocardiographic Outcomes After Surgical Redo Mitral Valve Replacement and Transcatheter Mitral Valve-in-Valve Therapy

Cited by 84 publications

References 30 publications

Hemodynamic and clinical response to transseptal mitral valve‐in‐valve and valve‐in‐ring

Hemodynamic and clinical response to transseptal mitral valve‐in‐valve and valve‐in‐ring

A meta‐analysis of valve‐in‐valve and valve‐in‐ring transcatheter mitral valve implantation

Transcatheter Mitral Valve-in-Valve—A Plausible Option but Questions Remain

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