Clinical Outcomes of Transcatheter Mitral Valve‐In‐Valve and Valve‐In‐Ring Implantation: A Systematic Review and Meta‐Analysis

ABSTRACT Background Transcatheter valve‐in‐valve (VIV) or valve‐in‐ring (VIR) therapies for degenerated mitral bioprosthetic valves and rings are still evolving. We aimed to characterize short‐ and long‐term outcomes of these procedures. Methods An electronic literature search was conducted to retrieve articles describing mitral VIV or VIR implantation with at least 10 patients. Meta‐analysis of proportions was carried out for 30‐day or in‐hospital outcomes of mortality, stroke, major bleeding, transfusion, acute kidney injury, procedural success, valve embolization, paravalvular leak, pacemaker implantation, and hospital stay. Individual patient data meta‐analysis using Kaplan‐Meier curve reconstruction was used to estimate long‐term mortality of VIV, VIR and redo surgical mitral valve replacement (SMVR). Results We analyzed 34 studies (7047 patients). Pooled procedural success was 94.8% in VIV and 80.5% in VIR. Pooled short‐term mortality and stroke risk was 6.4% and 1.9% respectively in VIV, 9.1% and 1.6% respectively in VIR, and 8.4% and 5.5% respectively in SMVR. Conclusions This study provides prognostic information on clinical outcomes for redo SMVR and transcatheter mitral VIV and VIR implantation.