Abstract 10070: Valve-in-Valve Transcatheter Mitral Valve Replacement versus Redo Surgical Mitral Valve Replacement-Sytemetaic Review and Meta-Analysis

Abstract

Introduction: Data on comparative outcomes between valve in valve transcatheter mitral valve replacement (ViV-TMVR) versus redo-surgical mitral valve replacement (SMVR) for degenerated bioprosthetic valves remain limited. Hypothesis: ViV TMVR is associated with lower in-hospital mortality and complication rates compared with redo SMVR. Methods: The MEDLINE (PubMed, Ovid) and Cochrane databases were queried with various combinations of medical subject headings (MeSH) to identify relevant articles. Eight studies evaluating comparative outcomes (ViV TMVR vs Redo SMVR) for patients with degenerated bioprosthetic valves were included in the analysis. Results: A total of 5,161 patients with degenerated prosthetic mitral valves underwent ViV TMVR (n = 1163) and redo SMVR (n = 3998) were included in the study. The mean age of patients was 76 versus 66 years for ViV TMVR versus the redo SMVR group, respectively (p<0.01). In terms of comorbidities, female gender (55% vs 53.4%), serum creatinine (1.52 vs 1.3), dialysis (6.4% vs 6.6% ), LVEF (55.56+/-9.5 vs 57.35+/-8.7), diabetes (20.2% vs 19.5%), hypertension (73.5% vs 63.4%), atrial fibrillation (64.5% vs 69% ), and mitral regurgitation (82.4% vs 80.5%) were similar between the ViV TMVR and redo SMVR groups respectively. Using a pooled analysis, in-hospital mortality, and major bleeding were significantly lower for patients undergoing ViV TMVR compared with redo SMVR. No significant difference was observed in the incidence of stroke. The length of stay was significantly lower in the ViV TMVR group compared with the redo SMVR group. Conclusions: ViV TMVR is associated with lower in-hospital mortality, complications, and length of hospital stay compared with redo SMVR for degenerated bioprosthetic valves.