Abstract
Introduction: Transcatheter mitral valve-in-valve (ViV) & valve-in-ring (ViR) are relatively novel therapeutic alternatives for patients with degenerated bioprostheses or failed annuloplasty rings whose reoperative risk is too high. The predominant procedural access for both procedures is transapical or transseptal. However, whether there are differences in outcomes of this procedure using transseptal versus transapical access has not yet been defined. Methods: We conducted a systematic review of all published articles from MEDLINE and EMBASE to explore the outcomes of these two procedural approaches. Results:total of 55 studies including 183 patients (154 ViV and 29 ViR) were included. Patients that underwent ViV (101 transapical and 53 transseptal) using the transseptal approach required more iatrogenic atrial septal defect (ASD) closure (19% versus 0.0 %; P < 0.001) and hence had a lower device success rate (68% versus 89%; P = 0.001). However, there was no significant difference between the two groups in procedural success and all-cause mortality at 30 days. Overall severe bleeding complications (major or life threatening) were not different the two groups (3.7% versus 7.9%; P = 0.321). In the ViR group (19 transapical and 10 transseptal), no difference in procedural success, device success or 30-day outcomes were identified between transseptal and transapical groups, although sample size was small. Conclusion: In conclusion, mitral ViV and ViR using the two different procedural approaches appear to confer equal and reasonable 30-day outcomes.
Highlights
Transcatheter mitral valve-in-valve (ViV) & valve-in-ring (ViR) are relatively novel therapeutic alternatives for patients with degenerated bioprostheses or failed annuloplasty rings whose reoperative risk is too high
Data from the United States Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) registry showed that transseptal placement increased from 14.6 % to 28.2 % in 2015.1 This trend bears some resemblance to procedural trends in transcatheter aortic valve replacement, in which initial experience was with transthoracic deployment approaches, was soon supplanted by transfemoral placement as reduction in sheath size allowed for placement via peripheral arterial access.[1,4]
Society of Thoracic Surgeons (STS) risk score were reported in 157 cases, which predicted a 30-day mortality of 15 ± 11.5 %, while logistic euroSCORES were reported in 91 cases and predicted an estimated surgical risk of 34.5 ± 16.5 %
Summary
Transcatheter mitral valve-in-valve (ViV) & valve-in-ring (ViR) are relatively novel therapeutic alternatives for patients with degenerated bioprostheses or failed annuloplasty rings whose reoperative risk is too high. Transcatheter mitral valve-in-valve (ViV) and valve-inring (ViR) procedures are relatively novel therapeutic alternatives for patients with degenerated bioprostheses or failed annuloplasty rings whose risk of surgical reoperation is deemed to be too high.[1,2] While transapical access was the first described approach,[3] this procedure requires a thoracotomy with its attendant risks. The purpose of this study was to evaluate and synthesize the published outcomes of transseptal versus transapical mitral ViV and ViR procedures to date
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