A Systematic Review of Transcatheter Mitral Valve-in-valve Replacement for Failed Prosthesis

Abstract

Transcatheter mitral valve-in-valve (TMVIV) for failed bioprosthetic valves is an emerging alternative to surgical re-operation in high risk patients. In this systematic review, we assessed the outcomes of mitral valve-in-valve replacement. Methods: A thorough computer-based search was performed using 4 major databases. We included studies utilising TMVIV replacement in failed bioprosthetic valves, mitral ring repairs and mitral clips. The 30-day and outcome of all-cause mortality, stroke, major bleeding and reintervention was analysed. Results: Seventeen observational studies were included in the analysis which comprised of 558 patients (437 bioprosthetic mitral valves, 110 mitral rings and 11 mitral clips). The mean age was 75 years with 39% of patients being male. 42.7% (238 patients) had New York Heart Association class 3 or 4 symptoms. The mean Society of Thoracic Surgeons score was 12.5%. Mean preoperative left ventricular ejection fraction was 55.5%. Patients with underlying mitral valve disease included 13.1% (73 patients) with mitral stenosis, 28% (158 patients) with mitral regurgitation and 10% (58 patients) with mixed mitral disease. Overall analysis demonstrated a low 30-day all-cause mortality of 2.5%. The rates of stroke and bleeding were also low at 0.7% (4 patients) and 6.8% (38 patients) respectively. 2.7% (16 patients) required reintervention with 0.4% (2 patients) needing surgical replacement and 0.4% (2 patients) with further valve-in-valve procedure. Conclusion: TMVIV is a safe and feasible option in patients with failed mitral valve prosthesis who are high surgical risk for re-operations.