Outcomes following transcatheter transseptal versus transapical mitral valve-in-valve and valve-in-ring procedures

Abstract

Introduction: Transcatheter mitral valve-in-valve (ViV) & valve-in-ring (ViR) are relatively novel therapeutic alternatives for patients with degenerated bioprostheses or failed annuloplasty rings whose reoperative risk is too high. The predominant procedural access for both procedures is transapical or transseptal. However, whether there are differences in outcomes of this procedure using transseptal versus transapical access has not yet been defined. Methods: We conducted a systematic review of all published articles from MEDLINE and EMBASE to explore the outcomes of these two procedural approaches. Results:total of 55 studies including 183 patients (154 ViV and 29 ViR) were included. Patients that underwent ViV (101 transapical and 53 transseptal) using the transseptal approach required more iatrogenic atrial septal defect (ASD) closure (19% versus 0.0 %; P < 0.001) and hence had a lower device success rate (68% versus 89%; P = 0.001). However, there was no significant difference between the two groups in procedural success and all-cause mortality at 30 days. Overall severe bleeding complications (major or life threatening) were not different the two groups (3.7% versus 7.9%; P = 0.321). In the ViR group (19 transapical and 10 transseptal), no difference in procedural success, device success or 30-day outcomes were identified between transseptal and transapical groups, although sample size was small. Conclusion: In conclusion, mitral ViV and ViR using the two different procedural approaches appear to confer equal and reasonable 30-day outcomes.

Contemporary treatment of mitral valve disease with transcatheter mitral valve implantation

“…Of note, transapical access yielded a higher all-cause mortality at one year in comparison with transseptal access (21.7 versus 15.8%) in the TVT registry [36]. However, Nazir et al did not find a difference regarding the 30-day mortality for both approaches [37]. This is important as the present design of the Tendyne valve does not allow a switch from transapical to transseptal implantation.…”

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

“…For patients with annuloplasty ring failure and severe MAC, further studies are needed in view of the high short-term morbidity and mortality feasibility. Transseptal TMVR, which eliminates the need for extracorporeal circulation and naturally reduces the risk, is considered a safer route to perform repeat valve surgery [ 19 , 41 ]. It has the advantages of less invasiveness, does not require opening the chest and avoids trauma to the left ventricle.…”

Design Variation, Implantation, and Outcome of Transcatheter Mitral Valve Prosthesis: A Comprehensive Review

“…Following the promising developments in TAVR devices, some of the earliest and common TMVI procedures were done using TAVR devices (e.g., Sapien M3, Sapien XT) via valve-invalve (VIV) approach in degenerated bioprostheses or severe MAC patients (63)(64)(65)(66). This is especially since redo surgery for the degenerated bioprosthetic mitral valve in elderly patients with impaired left ventricular dysfunction and previous cardiac surgery is not ideal (67).…”