Transcatheter mitral valve implantation versus conventional redo surgery for degenerated mitral valve prostheses and rings in a multicenter registry

Abstract

Objectives

Degeneration of mitral prostheses/rings may be treated by redo surgery, and, recently, by transcatheter valve-in-valve/ring implantation. This multicenter registry presents results of transcatheter valve-in-valve and repeat surgery for prostheses/rings degeneration.

Methods

Data provided by 10 German Heart Centers underwent propensity score matched (PSM) retrospective analysis. Primary end-point was 30-day/mid-term mortality. Perioperative outcome was assessed according to the Mitral Valve Academic Research Consortium Criteria. Further, the influence of ≥moderate tricuspid regurgitation (TR) on 30-day/mid-term mortality was analyzed. P-value <0.05 was significant for all parameters.

Results

Between 2014-2019, 273 patients (79 transcatheter (TM-ViV) and 194 surgical (Re-MVR)) underwent repeat procedure for mitral prosthesis/ring degeneration. PSM distinguished 79 patient pairs. EuroScore II-predicted risk was 15.7±13.7% in TM-ViV and 15.0%±12.7% in Re-MVR group, p=0.5336. TM-ViV patients were older (74.73 vs. 72.2 years, p=0.0030) and had higher incidence of atrial fibrillation (54 vs. 40 pts., p=0.0233). Severe TR incidence was similar (17.95% in TM-ViV vs. 14.10%, p=0.1741). 68 TM-ViV-patients previously underwent mitral valve replacement, whereas 41 Re-MVR-patients underwent valve repair (p<0.0001). Stenosis was leading degeneration mechanism in 42 TM-ViV vs. 22 Re-MVR patients, p<0.0005. The 30-day/mid-term mortality did not differ between groups. TR ≥moderate was predictor of total (OR 4.36, p=0.0011), 30-day (OR 3.76, p=0.0180) and mid-term mortality (OR 4.30, p=0.0378), irrespective of group.

Conclusions

In both groups, observed mortality was lower than predicted. Redo surgery enabled treatment of concomitant conditions, such as atrial fibrillation or TR. TR was shown to be a predictor of total, 30-day- and mid-term mortality in both groups.