Transcatheter Mitral Valve-in-Valve Superior to Redo Surgery in Patients with Failed Mitral Bioprostheses: Study
USA: The SURViV trial suggests that transcatheter mitral valve-in-valve (ViV) procedures are a safe and effective option for patients with failed mitral bioprostheses. At 1 year, ViV was associated with significantly lower rates of all-cause mortality and stroke compared to redo surgery, while both approaches improved symptoms and quality of life.
New findings from the SURViV study, presented at the American College of Cardiology (ACC.26) meeting, provide important evidence supporting the use of transcatheter mitral valve-in-valve (mVIV) therapy as an alternative to repeat surgical mitral valve replacement (rMVR). The trial, conducted across seven cardiovascular centers in Brazil, compared outcomes between the two approaches in patients with dysfunctional mitral bioprosthetic valves.
The study enrolled 150 patients with severe symptomatic valve failure, with a mean age of 58 years, and a predominance of women. Participants were randomly assigned to undergo either mVIV or conventional redo surgery. Notably, a substantial proportion of patients had complex clinical profiles, including prior valve surgeries, pulmonary hypertension, atrial fibrillation, and underlying rheumatic heart disease.
The researchers reported the following findings:
- At 1 year, the composite outcome of all-cause death or disabling stroke was significantly lower in the mVIV group (5.3%) compared to the repeat surgery group (20.8%), indicating a substantial reduction in risk with the transcatheter approach.
- The observed difference in outcomes was largely driven by complications occurring in the early postoperative period among patients undergoing surgical valve replacement.
- Within 30 days, cardiovascular mortality was higher in the surgical group, whereas no cardiovascular deaths were reported in the mVIV group.
- Postoperative complications, including acute kidney injury and major or life-threatening bleeding, were more frequently observed in patients undergoing repeat surgery.
- Stroke rates were low and comparable between the two treatment groups.
- Hemodynamic performance of the mitral valve was generally similar between mVIV and surgical groups over time, with comparable mitral gradients and valve area measurements at both 3 months and 1 year.
- These findings indicate that mVIV provides adequate valve function alongside its clinical benefits.
- Both treatment strategies led to significant improvements in patient symptoms and overall quality of life.
The study was limited by its small sample size and single-country design, which may affect generalizability. A high burden of rheumatic heart disease and pulmonary hypertension could have influenced outcomes. Although unblinded, endpoints were independently adjudicated.
According to the principal investigator, Dimytri Siqueira, these results suggest that transcatheter valve-in-valve therapy offers short-term benefits in high-risk patients, noting this is the first randomized comparison with repeat surgery. He emphasized the need for long-term follow-up, with patients to be tracked for 10 years.
Overall, the findings indicate that transcatheter mitral valve-in-valve therapy may offer a safer short-term alternative to repeat surgery in selected patients. Ongoing long-term follow-up will be essential to determine durability and define its role in broader clinical practice.
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