Transcatheter valve-in-valve or redo surgical mitral valve replacement, which is better in failed mitral bioprostheses?
USA: A study comparing the safety of valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) and redo surgical mitral valve replacement (SMVR) found ViV-TMVR to be associated with a lower risk of complications, in-hospital mortality, and resource utilization in patients with a history of the bioprosthetic mitral valve (MV).
The study, published in EuroIntervention, found comparable 30-day and 6-month mortality and all-cause readmissions during the readmission episode in both groups.
Considering the limited data on the safety of ViV-TMVR compared with redo SMVR in patients with a history of the bioprosthetic mitral valve, Salman Zahid, Department of Medicine, Rochester General Hospital, Rochester, NY, USA, and colleagues aimed to evaluate the 30-day and 6-month, in-hospital readmission outcomes of ViV-TMVR compared with redo-SMVR in a cohort of real-world.
Working towards their objective, the researchers analyzed data from 2015 to 2019 using the Nationwide Readmission Database. The propensity-matched analysis was used to determine the adjusted odds ratio (aOR) for primary outcomes at index hospitalization, 30 days, and six months during the readmission episode. Three thousand six hundred ninety-one patients were included, of which 24.2% underwent ViV-TMVR, and 75.8% underwent redo-SMVR.
The study led to the following findings:
- Patients undergoing ViV-TMVR were older with higher comorbidity rates.
- The mean length of stay (15 days vs. four days) and hospitalization costs ($76,558 vs. $46,743) were significantly more significant for redo-SMVR.
- Also, the rate of in-hospital all-cause mortality was notably lower in ViV-TMVR (2.6% vs. 7.3%).
- By contrast, both groups were comparable between 30-day all-cause mortality during the readmission episode (aOR 1.01) and all-cause readmission rates (aOR 0.82).
- The incidence of all-cause readmissions at six months (aOR 0.83) and all-cause mortality during the episode of readmission at six months (aOR 1.84) were also similar.
- The utilization of the ViV-TMVR procedure increased significantly during the study duration, from 5.2% to 36.8%.
"We found that ViV-TMVR is linked with lower odds of complications, in-hospital mortality, and resource utilization," the researchers wrote. "The all-cause readmissions and mortality of 30-day and 6-month during the readmissions were comparable between both groups."
Reference:
Zahid S, Ullah W, Hashem AM, Khan MZ, Gowda S, Vishnevsky A, Fischman DL. Transcatheter valve-in-valve implantation versus redo surgical mitral valve replacement in patients with failed mitral bioprostheses. EuroIntervention. 2022 Sep 15:EIJ-D-22-00437. doi: 10.4244/EIJ-D-22-00437. Epub ahead of print. PMID: 36106346.
