Transcatheter mitral valve implantation for degenerated mitral bioprostheses or failed surgical annuloplasty rings: A systematic review and meta-analysis

Hu, Junjie; Chen, Yan; Cheng, Sen; Zhang, San; Wu, Kaiqin; Wang, Wenli; Zhou, Yilu

doi:10.1111/jocs.13767

Cited by 36 publications

(47 citation statements)

References 106 publications

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“…The introduction of transcatheter approaches to mitral valve disease will likely increase in higher risk patients undergoing reoperative surgery. These include valve‐in‐valve and valve‐in‐ring replacement via peripheral and transapical approaches . These techniques have been safe and effective short‐term, but long‐term data are lacking.…”

Section: Discussionmentioning

confidence: 99%

Redo mitral valve surgery following prior mitral valve repair

et al. 2018

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Background: The optimal treatment strategy following a failed mitral valve repair remains unclear. This study evaluated early and long-term outcomes of redo mitral valve repair (MVr) and replacement (MVR) after prior mitral valve repair. Methods: Patients undergoing redo mitral valve surgery after prior mitral valve repair at a single institution between 2002 and 2014 were reviewed. Primary outcomes included operative mortality (30-day or in-hospital mortality) and long-term freedom from mitral valve reoperation and death. Secondary outcomes included postoperative complications.Results: 305 patients underwent redo MVr (n = 48) or MVR (n = 257) after prior mitral valve repair. Concomitant procedures included tricuspid valve repair or replacement (23%), aortic valve replacement (6%), and coronary artery bypass grafting (4%), with no differences between cohorts. 18% were performed via right mini-thoracotomy (24% MVr vs 18% MVR, P = 0.31). Unadjusted and risk-adjusted operative mortality were lower with MVr (0% vs 8%, P = 0.04). Rates of postoperative complications were similar except for blood product transfusion (35% MVr vs 59% MVR, P = 0.003) and prolonged mechanical ventilation (8% MVr vs 29% MVR, P = 0.003). Long-term freedom from mortality was comparable: 96% MVr versus 86% MVR at 1 year and 78% MVr versus 68% MVR at 5 years (P = 0.29).Conclusions: When technically feasible, mitral valve re-repair can be safely performed with outcomes comparable to MVR. K E Y W O R D Sminimally invasive, mitral valve, outcomes, reoperative surgery, repair, replacement, survival

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Section: Discussionmentioning

confidence: 99%

Redo mitral valve surgery following prior mitral valve repair

et al. 2018

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“…In certain patients with significant comorbidities, redo surgery may be associated with an early mortality as high as 5%–12% . In recent years, transcatheter valve‐in‐valve options have become available for such high‐risk individuals . These transcatheter valves are most often implanted through a transseptal approach which is less invasive than the transapical route as demonstrated in our patient .…”

Section: Discussionmentioning

confidence: 84%

“…The pathogenesis of bioprosthetic valve commissural fusion is uncertain. Vainrib et al have reported a 77‐year‐old woman who developed bioprosthetic mitral stenosis due to commissural fusion 6 months after implantation of a bovine bioprosthesis. She underwent percutaneous balloon valvuloplasty with redevelopment of stenosis 2 years after requiring transapical valve‐in‐valve prosthesis.…”

Section: Discussionmentioning

confidence: 99%

Commissural fusion as etiology of bioprosthetic mitral stenosis in a patient with rheumatic heart disease

et al. 2020

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We report commissural fusion as a unique morphologic etiology of early bioprosthetic mitral valve failure in a woman with a history of rheumatic mitral stenosis. She had undergone mitral valve replacement with a 25‐mm Edwards Magna Ease bovine pericardial bioprosthesis 3 years earlier and presented with progressive dyspnea. Transesophageal echocardiography revealed severe bioprosthetic stenosis due to commissural fusion. She underwent percutaneous valve‐in‐valve implantation with a 26‐mm Edwards Sapien 3 prosthesis. Marked symptomatic improvement was noted postprocedurally. We speculate that commissural fusion may be a unique pathologic feature of failing bioprosthetic valves in patients with prior rheumatic mitral valve disease.

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“…Mortality at 30 days was 6.5%, which was lower than the predicted operative mortality (STS‐PROM) of 8.9 ± 6.8%. In a meta‐analysis including a total of 245 patients undergoing VIV‐TMVR (70.2%) and VIR‐TMVR (29.8%), 30‐day mortality was 8.1%. In our meta‐analysis, observed 30‐day mortality was approximately two to threefold higher (20.4% versus 6.5% and 8.1%) compared with patients undergoing VIV‐TMVR and VIR‐TMVR.…”

Section: Discussionmentioning

confidence: 99%

“…In a meta‐analysis including a total of 245 patients undergoing VIV‐TMVR (70.2%) and VIR‐TMVR (29.8%), 30‐day mortality was 8.1%. In our meta‐analysis, observed 30‐day mortality was approximately two to threefold higher (20.4% versus 6.5% and 8.1%) compared with patients undergoing VIV‐TMVR and VIR‐TMVR. The reason for the higher 30‐day mortality in MR patients undergoing TMVR than patients undergoing VIV‐TMVR and VIR‐TMVR is unclear but may be related to a higher incidence of co‐morbidities in the native MR patients.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter mitral valve replacement for mitral regurgitation-A meta-analysis

et al. 2018

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Objectives:We performed a meta-analysis to determine the outcomes in patients undergoing transcatheter mitral valve replacement (TMVR) for mitral regurgitation (MR).Methods: Databases including MEDLINE and EMBASE were searched through April 2018 using Web-based search engines (PubMed and OVID) to identify single-arm observational (case series) studies of TMVR enrolling ≥5 patients with MR. For each study, data regarding observed 30-day mortality and predicted operative mortality (Society of Thoracic Surgeons Predicted Risk of Mortality) 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. One-group meta-analyses of 30-day and >30-day (including 30-day) mortality were also performed in the random-effects model. Results:Of 222 potentially relevant articles screened initially, nine eligible studies enrolling a total of 146 patients with MR undergoing TMVR were identified. In all but two studies, STS-PROM was available and varied from 3.3% to 15.4% (arithmetic mean, 7.6%). Pooled analyses demonstrated 30-day mortality of 20.4% (95%CI, 9.6-31.2%), >30-day mortality of 32.0% (95%CI, 19.8-44.2%), and non-significantly higher observed 30-day mortality than predicted operative mortality (RR, 1.70; 95%CI, 0.85-3.42; P = 0.14). There was no evidence of significant publication bias.Conclusion: TMVR for patients with MR results in increased early and late mortality. K E Y W O R D S meta-analysis, mitral regurgitation, mortality, transcatheter mitral valve replacement 1 | INTRODUCTION Available percutaneous options for mitral valve (MV) repair and replacement for high surgical-risk patients are increasing. 1 The shape of the MV is oval and saddle-like, and the annulus is not stiff, which makes it challengeable to implant a prosthesis within the MV. 2 Several biologic self-expanding prostheses haves been currently and clinically developed. 3-10 Although transcatheter aortic valve replacement (TAVR) for low-to-moderate or moderate-to-high-risk patients with severe aortic stenosis (AS) is an established therapy, 11,12 transcatheter mitral valve replacement (TMVR) for patients with severe symptomatic mitral regurgitation (MR) is still considered to be an evolving less-invasive alternative to open MV surgery (MVS) including repair and replacement. 13 Neither observational comparative studies nor J Card Surg. 2018;33:827-835. wileyonlinelibrary.com/journal/jocs © 2018 Wiley Periodicals, Inc. | 827randomized controlled trials (RCTs) of TMVR versus conventional MVS has been conducted to date, and results of TMVR are limited to a small number of single-arm observational (case series) studies.We performed a meta-analysis to determine the perioperative and post-discharge mortality following TMVR. | MATERIALS AND METHODSWe found studies of TMVR enrolling patients with MR by means of the following search strategy: MEDLINE and EMBASE searches were conducted up to April 2018 by use of PubMe...

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Transcatheter mitral valve implantation for degenerated mitral bioprostheses or failed surgical annuloplasty rings: A systematic review and meta-analysis

Cited by 36 publications

References 106 publications

Redo mitral valve surgery following prior mitral valve repair

Redo mitral valve surgery following prior mitral valve repair

Commissural fusion as etiology of bioprosthetic mitral stenosis in a patient with rheumatic heart disease

Transcatheter mitral valve replacement for mitral regurgitation-A meta-analysis

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