Mitral Valve Replacement Research Articles

B-60 | Impact of Pulmonary Hypertension on Long-Term Outcome After Transcatheter Mitral Valve Replacement: A Meta- Analysis

B-60 | Impact of Pulmonary Hypertension on Long-Term Outcome After Transcatheter Mitral Valve Replacement: A Meta- Analysis

A Modified Tip-to-Base LAMPOON to Prevent Left Ventricular Outflow Tract Obstruction in Valve-in-Ring or Valve-in-Valve Transcatheter Mitral Valve Replacement.

The Laceration of the Anterior Mitral leaflet to Prevent Outflow ObtructioN (LAMPOON) procedure may be performed from the leaflet tip to base to prevent left ventricular outflow tract obstruction (LVOTO) in patients with high-risk anatomy undergoing valve-in-valve (VIV) or valve-in-(complete)-ring (VIR) transcatheter mitral valve replacement (TMVR). Thirteen consecutive patients (6 females, average age 67.7 years) with a mean left ventricular ejection fraction of 60%, a median STS score of 3.2%, and degenerative surgical mitral bioprosthesis or ring were treated with a combined, single-stage procedure of preventive LAMPOON and trans-septal TMVR with SAPIEN 3 valves (Edwards Lifesciences, Irvine, CA). Under real-time 3-dimensional transesophageal echocardiography (RT 3D-TEE) guidance, we included the rendezvous technique in the LAMPOON procedure, and all 13 patients were successfully treated by tip-to-base LAMPOON and TMVR. The use of a modified LAMPOON procedure, aided by a rendezvous technique and guided by RT 3D-TEE imaging, offers precise guidance for positioning and aligning the guidewire. This approach not only reduces the need for fluoroscopy and shortens procedure times, but also significantly increases the likelihood of a successful outcome. Importantly, none of the patients in our study experienced unintentional aortic or aortic valve injuries, nor did they develop significant LVOTO following TMVR. In 11 of the 13 (85%) patients, we used a transcatheter SENTINELTM cerebral protection device (Boston Scientific, Marlborough, MA) for stroke prevention and capture of debris ≥ 2 mm were detected in 8/11 (73%) of the cases. Utilizing intra-operative RT 3D-TEE in conjunction with the rendezvous technique can make the tip-to-base LAMPOON procedure even safer and more effective for patients undergoing VIV or VIR TMVR. Our study also suggests that cerebral protection is indicated in patients undergoing TMVR.

Role of Transthoracic Echocardiography to Predict Post-Operative Atrial Fibrillation after Mitral Valve Replacement

Role of Transthoracic Echocardiography to Predict Post-Operative Atrial Fibrillation after Mitral Valve Replacement

Case report on Pharmacogenetic guided warfarin dosing in a postoperative valve replacement patient

Patient underwent mitral valve replacement with mechanical valve and was initiated on oral anticoagulation with standard dose of warfarin. She developed supra therapeutic INR levels. Genotyping of CYP2C9 and VKORC1 encoding genes revealed homozygous variation of CYP2C9*3*3 and heterozygous variation of VKORC1 G>A making her hypersensitive to warfarin. Based on this study result and Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline, a low dose of warfarin (0.5mg per day) was prescribed, to achieve a therapeutic INR of 2.5 to 3.5 and adverse drug effects were avoided.

New echocardiographic screening tool for left ventricular tract obstruction risk assessment in TMVR

BackgroundTranscatheter mitral valve replacement (TMVR) is an alternative to conventional surgery to treat severe mitral disease but its use is limited by the risk of left ventricular outflow tract obstruction (LVOTO). Screening depends on ECG-gated computed tomography (CT) that is not widely available and requires contrast. We developed and validated a transthoracic echocardiographic (TTE) method to assess the risk of LVOTO after TMVR with the Tendyne System. MethodsWe measured the LVOT longitudinal area on preoperative TTE dataset of patients screened for TMVR. The LVOT was measured as the box-area included by the aortic valve annulus, the anterior mitral leaflet (AML), the c-septum distance line, and the respective length of the AML on the interventricular septum. We analyzed the correlation between the TTE LVOT-box and the CT-measured neoLVOT area. Prediction performance for eligible patients was tested with ROC curves. ResultsThirty-nine patients were screened, out of 14 patients (36%) not eligible for TMVR, 8 had risk of LVOTO. We found a linear correlation between the TTE LVOT-box and the CT-measured Neo-LVOT (r = 0.6, p = 0.002). ROC curve showed that the method is specific and sensitive and the cut-off value of the measure LVOT-box is 350 mm2. ConclusionsThe proposed method is reliable to evaluate the risk of LVOTO after TMR with the Tendyne System. It is quick and easy and can be used as a first-line assessment in the outpatient clinic. Patients with LVOT-box <350 mm2 should not be further screened with ECG-gated cardiac CT.

Rare Case of Infective Endocarditis Due to Gemella Morbillorum in Patient with Bicuspid Aortic Valve

Infective endocarditis caused by Gemella morbillorum is one of the rare causative microorganisms of endocarditis and only a few cases have been reported in the literature so far. We describe a case of Gemella morbillorum endocarditis in a 37-year-old Moroccan man who had a congenitally bicuspid aortic valve. He presented to our institution with a 1.5-month history of fever, and the onset of a motor deficit in the right hemibody one day prior to consultation. A transthoracic echocardiogram showed two large, echogenic and mobile vegetations (30×8 mm) with perforation of the left cusp and fistulized abscess of the anterior mitral leaflet measuring approximately 16x20mm. Blood cultures of the patient grew pan-sensitive Gemella morbillorum. The patient fulfilled the Duke’s criteria for infective endocarditis. The patient was successfully treated with antibiotics and aortic and mitral valves replacement.

So sánh chất lượng cuộc sống của người bệnh sau phẫu thuật tim ít xâm lấn có nội soi hỗ trợ và phẫu thuật mở thay van hai lá cơ học tại Trung tâm Tim mạch Bệnh viện E

Objective: Evaluate the quality of life of patients after minimally invasive open heart surgery with endoscopically assisted mitral valve replacement at Hospital E Heart Center and compare the quality of life of patients after surgery Minimally invasive open heart with endoscopic assisted mitral valve replacement and patients after mitral valve replacement surgery using open surgery. Research subjects and methods: Cross-sectional descriptive study on 54 cases after minimally invasive open heart surgery with endoscopic assisted mitral valve replacement at E Hospital Heart Center from January 1, 2022 to March 30 June 2023, using the SF-36 questionnaire. Results: Average scores of 4 areas of physical health including functional activities, functional limitations, pain perception and general health of the group of patients after minimally invasive surgery assisted by endoscopy and The group of patients with open surgery were: 81,03 and 74 respectively; 79,5 and 72,5; 93,97 and 76,16; 62,31 and 56,67. The average scores of 4 mental health domains including sense of vitality, social activities, psychological limits and general spirit are: 78,46 and 74 respectively; 75 and 67,92; 81,41 and 73,89; 85,9 and 79,17. Conclusion: The quality of life scores of patients after minimally invasive open heart surgery with endoscopically assisted mitral valve replacement in all areas are at good and good levels, higher than the group of patients undergoing replacement surgery. mitral valve by open surgery. Therefore, minimally invasive open heart surgery with endoscopically assisted mitral valve replacement is an indication for clear improvement in patients after surgery.

Predictive nomogram for 28-day mortality risk in mitral valve disorder patients in the intensive care unit: A comprehensive assessment from the MIMIC-III database

BackgroundMitral valve disorder (MVD) stands as the most prevalent valvular heart disease. Presently, a comprehensive clinical index to predict mortality in MVD remains elusive. The aim of our study is to construct and assess a nomogram for predicting the 28-day mortality risk of MVD patients. MethodsPatients diagnosed with MVD were identified via ICD-9 code from the MIMIC-III database. Independent risk factors were identified utilizing the LASSO method and multivariate logistic regression to construct a nomogram model aimed at predicting the 28-day mortality risk. The nomogram's performance was assessed through various metrics including the area under the curve (AUC), calibration curves, Hosmer-Lemeshow test, integrated discriminant improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA). ResultsThe study encompassed a total of 2771 patients diagnosed with MVD. Logistic regression analysis identified several independent risk factors: age, anion gap, creatinine, glucose, blood urea nitrogen level (BUN), urine output, systolic blood pressure (SBP), respiratory rate, saturation of peripheral oxygen (SpO2), Glasgow Coma Scale score (GCS), and metastatic cancer. These factors were found to independently influence the 28-day mortality risk among patients with MVD. The calibration curve demonstrated adequate calibration of the nomogram. Furthermore, the nomogram exhibited favorable discrimination in both the training and validation cohorts. The calculations of IDI, NRI, and DCA analyses demonstrate that the nomogram model provides a greater net benefit compared to the Simplified Acute Physiology Score II (SAPSII), Acute Physiology Score III (APSIII), and Sequential Organ Failure Assessment (SOFA) scoring systems. ConclusionThis study successfully identified independent risk factors for 28-day mortality in patients with MVD. Additionally, a nomogram model was developed to predict mortality, offering potential assistance in enhancing the prognosis for MVD patients. It's helpful in persuading patients to receive early interventional catheterization treatment, for example, transcatheter mitral valve replacement (TMVR), transcatheter mitral valve implantation (TMVI).

Unveiling the mystery: Infective endocarditis as an etiological cause of recurrent intracranial hemorrhage

Intracerebral hemorrhage (ICH) in the context of infective endocarditis (IE) is an uncommon and complex phenomenon involving diverse underlying mechanisms. We present a compelling case of a 48-year-old patient with recurrent ICH, ultimately leading to the diagnosis of IE with vegetation on the anterior leaflet of the mitral valve. The patient underwent a successful mitral valve replacement followed by a gradual improvement in neurological symptoms. This case report delves into the intricate diagnostic journey, highlighting the significance of suspecting IE in patients presenting with ICH. A multidisciplinary and comprehensive management approach played a pivotal role in achieving positive outcomes.

Early and mid-term outcomes of minimally invasive mitral valve surgery in high operative risk patients at University Medical Center, Ho Chi Minh City

Introduction: Minimally invasive mitral valve surgery (MIMVS) has seen significant advancement in the past decades, offering numerous benefits to patients. However, there remain cohorts of patients with mitral valve pathologies, deemed at higher surgical risk, who may face rejection for MIMVS due to concerns regarding potential postoperative complications associated with this approach. Objective: To assess early and midterm outcomes of MIMVS in higher-operative-risk patients at the University Medical Center of Ho Chi Minh City. Methods: A retrospective descriptive study of the patients meeting our high operative risk criteria, who underwent mitral valve surgery at the University Medical Center of Ho Chi Minh City from January 2017 to March 2023. Results: A total of 68 eligible cases were included in our study. The male-to-female ratio was 0.6:1. Among these cases, 21 patients underwent valve repair and 47 others underwent mitral valve replacement. 30.9% of cases presented with NYHA class III or above heart failure. The mean cardiopulmonary circulation time and aortic cross-clamp time were 157.4 ± 38.8 minutes and 102.7 ± 26.3 minutes, respectively. Three cases experienced minimally invasive surgery related complications, including one case of limb ischemia requiring fasciotomy, one case of femoral wound seroma, and one case of postoperative wound infection necessitating debridement. No instances of conversion to sternotomy or in-hospital mortality were observed. The mean ICU stay and postoperative length of stay at ward were 4.6 ± 3.5 days and 10.8 ± 5.9 days, respectively. Patients showed rapid recovery during the postoperative period. During ICU care, one patient suffered a non-disabling cerebrovascular accident, one case required continuous renal replacement therapy, three cases necessitated intra-aortic balloon pump placement, and three cases required reoperation due to hemorrhagic pleural effusion. During follow-up period, three patients died within 6 months, and another patient died after their surgery one year. Other patients had favorable outcomes at the time of discharge and at subsequent follow-up. Conclusion: Minimally invasive mitral valve surgeries highlight the feasibility and safety of minimally mitral valve surgery in higher-operative-risk patients.

Prevalence, mortality, cost, and disparities in transcatheter mitral valve repair and replacement in cancer patients: Artificial intelligence and propensity score national 5-year analysis of 7495 procedures

IntroductionWe conducted the first comprehensive evaluation of the therapeutic value and safety profile of transcatheter mitral edge-to-edge repair (TEER) and transcatheter mitral valve replacement (TMVR) in individuals concurrently afflicted with cancer. MethodsUtilizing the National Inpatient Sample (NIS) dataset, we analyzed all adult hospitalizations between 2016 and 2020 (n = 148,755,036). The inclusion criteria for this retrospectively analyzed prospective cohort study were all adult hospitalizations (age 18 years and older). Regression and machine learning analyses in addition to model optimization were conducted using ML-PSr (Machine Learning-augmented Propensity Score adjusted multivariable regression) and BAyesian Machine learning-augmented Propensity Score (BAM-PS) multivariable regression. ResultsOf all adult hospitalizations, there were 5790 (0.004%) TMVRs and 1705 (0.001%) TEERs. Of the total TMVRs, 160 (2.76%) were done in active cancer. Of the total TEERs, 30 (1.76%) were done in active cancer. After the comparable rates of TEER/TMVR in active cancer in 2016, the prevalence of TEER/TMVR was significantly less in active cancer from 2017 to 2020 (2.61% versus 7.28% p < 0.001). From 2017 to 2020, active cancer significantly decreased the odds of receiving TEER or TMVR (OR 0.28, 95%CI 0.13–0.68, p = 0.008). In patients with active cancer who underwent TMVR/TEER, there were no significant differences in socio-economic disparities, mortality or total hospitalization costs. ConclusionThe presence of malignancy does not contribute to increased mortality, length of stay or procedural costs in TMVR or TEER. Whereas the prevalence of TMVR has increased in patients with active cancer, the utilization of TEER in the context of active cancer is declining despite a growing patient population.

Simultaneous transapical transcatheter aortic and mitral valve replacement in patients with severe valve dysfunction: initial experience.

Simultaneous transcatheter mitral valve in valve (VIV) replacement and aortic valve replacement experience is limited. We report our initial experience with simultaneous transapical transcatheter aortic and mitral valve replacement in patients with severe valve dysfunction. A total of 8 patients had simultaneous transcatheter heart valve implants for severe mitral bioprosthesis failure (VIV), with a second valve procedure that included native aortic regurgitation (n = 3) or degenerated bioprostheses in the aortic position (n = 5). All patients were treated with a self-expandable J-valve transcatheter valve, using the transapical approach. The mean age of the patients was 73.1 ± 6.2years. The mean Society of Thoracic Surgeons score was 13.8 ± 6.3%. Device success was 100% according to Valve Academic Research Consortium-2 criteria. No other procedure-associated complications occurred, including left ventricular outflow tract obstruction and valve migration. The mean hospital lengths of stay after the procedure were 11.5 ± 8.0days. No deaths occurred at 30days. At a median follow-up period of 28.7 ± 22.3months, no patients died. All patients were in New York Heart Association functional classes I-II. Echocardiographic parameters at follow-up showed a normofunctioning J valve in the mitral position and a mean max mitral flow velocity of 2.0 ± 0.5m/s; the J valve in the aortic position was also normofunctioning, and the mean max aortic flow velocity was 2.3 ± 0.5m/s. Simultaneous transapical transcatheter aortic and mitral valve replacement using the self-expandable J valve appears to be a feasible and effective alternative to redo surgery.

Case Report: Post-operative mitral valve replacement complicating with a large cardiac mass and role of TEE in decision making

Background Postoperative complications are an integral part of valve surgery. Common complications include hematomas, bleeding, valve dehiscence, paravalvular leak, and acute PV thrombosis. With the available data from published articles, the rate of all valve-related complications is 0.7 to 3.5% per patient annually. [1] The pathology involved is multifactorial, often blood vessel injury leading to bleeding and hematoma. Although postoperative complications are evident, incidental diagnosis of a cardiac mass in an asymptomatic and hemodynamically stable patient postoperatively is crucial, requiring non-invasive imaging for immediate surgical action. Case presentation A woman in her 50s presented with chief complaints of worsening dyspnoea with suddenonset and chest pain. Clinical findings showed apex shifted downward and outward, wide split S2, and a mid systolic murmur radiating to the mid axillary line. Twelve-lead ECG showed LA enlargement, that aligned with X-ray findings. 2D Echocardiography revealed MVP with severe MR and a dilated LV. The patient underwent successful mitral valve replacement as per ACC/AHA class I recommendation. However, postoperative TTE showed a remarkably large mass measuring 5.6 cm*4.6 cm in the RA. Reexploration was performed, followed by mass excision. Plenty of organized clots were seen compressing the RA. TEE showed no evidence of mass. Following stabilization,the patient was discharged considering optimal INR values and prosthetic valve function assessed by echocardiography. The patient’s symptoms improved during the first follow-up. Conclusion Although postoperative cardiac complications are common, appropriate diagnosis with TTE and TEE has benefited surgeons. TEE-guided reexploration aids surgeons in decision-making and strategic approaches. Failure to diagnose such complications in asymptomatic patients can ultimately complicate the procedure. Henceforth, sonographers must be skilled in the detection and identification of unusual complications to guide redo interventions. Such an approach minimizes mortality, redo procedures, and avoids CPB hence reducing long-term prognosis and outcomes with valve replacement.

Left atrial function in patients with rheumatic mitral stenosis: addressing prognostic insights beyond atrial fibrillation prediction.

Rheumatic mitral stenosis (MS) frequently leads to impaired left atrial (LA) function because of pressure overload, highlighting the underlying atrial pathology. Two-dimensional speckle tracking echocardiography (2D-STE) offers early detection of LA dysfunction, potentially improving risk assessment in patients with MS. This study aims to evaluate the predictive value of LA function assessed by 2D-STE for clinical outcomes in patients with MS. Between 2011 and 2021, patients with MS underwent LA function assessment using 2D-STE, with focus on the reservoir phase (LASr). Atrial fibrillation (AF) development constituted the primary outcome, with death or valve replacement as the secondary outcome. Conditional inference trees were employed for analysis, validated through sample splitting. The study included 493 patients with MS (mean valve area 1.1 ± 0.4 cm2, 84% female). At baseline, 166 patients (34%) had AF, with 62 patients (19%) developing AF during follow-up. LASr emerged as the primary predictor for new-onset AF, with a threshold of 17.9%. Over a mean 3.8-year follow-up, 125 patients (25%) underwent mitral valve replacement, and 32 patients (6.5%) died. A decision tree analysis identified key predictors such as age, LASr, severity of tricuspid regurgitation (TR), net atrioventricular compliance (C n), and early percutaneous mitral valvuloplasty, especially in patients aged ≤49 years, where LASr, with a threshold of 12.8%, significantly predicted adverse outcomes. LASr emerged as a significant predictor of cardiovascular events in this MS cohort, validated through a decision tree analysis. Patients were stratified into low- or high-risk categories for adverse outcomes, taking into account LASr, age, TR severity, and C n.

Staphylococcus lugdunensis Endocarditis Presenting with Brain Abscesses and Temporal Vision Deficits

Staphylococcus lugdunensis Endocarditis Presenting with Brain Abscesses and Temporal Vision Deficits

Clinical characteristics and outcomes of alcohol septal ablation in the era of transcatheter valve interventions.

The clinical efficacy and safety of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) have been well-established; however, less is known about outcomes in patients undergoing preemptive ASA before transcatheter mitral valve replacement (TMVR). The goal of this study is to characterize the procedural characteristics and examine the clinical outcomes of ASA in both HCM and pre-TMVR. This retrospective study compared procedural characteristics and outcomes in patient who underwent ASA for HCM and TMVR. In total, 137 patients were included, 86 in the HCM group and 51 in the TMVR group. The intraventricular septal thickness (mean 1.8 vs. 1.2 cm; p < 0.0001) and the pre-ASA LVOT gradient (73.6 vs. 33.8 mmHg; p ≤ 0.001) were higher in the HCM group vs the TMVR group. The mean volume of ethanol injected was higher (mean 2.4 vs. 1.7 cc; p < 0.0001). The average neo-left ventricular outflow tract area increased significantly after ASA in the patients undergoing TMVR (99.2 ± 83.37 mm2 vs. 196.5 ± 114.55 mm2; p = <0.0001). The HCM group had a greater reduction in the LVOT gradient after ASA vs the TMVR group (49.3 vs. 18 mmHg; p = 0.0040). The primary composite endpoint was higher in the TMVR group versus the HCM group (50.9% vs. 25.6%; p = 0.0404) and had a higher incidence of new permanent pacemaker (PPM) (25.5% vs. 18.6%; p = 0.3402). The TMVR group had a higher rate of all-cause mortality (9.8% vs. 1.2%; p = 0.0268). Preemptive ASA before TMVR was performed in patients with higher degree of clinical comorbidities, and correspondingly is associated with worse short-term clinical outcomes in comparison to ASA for HCM patients. ASA before TMVR enabled percutaneous mitral interventions in a small but significant minority of patients that would have otherwise been excluded. The degree of LVOT and neoLVOT area increase is significant and predictable.

To repair or to replace in mitral valve infective endocarditis? an updated meta-analysis

BackgroundValve infective endocarditis (IE) is a potentially life-threatening condition that affects patients’ livelihoods. Current surgical options in mitral valve IE include mitral valve repair (MVr) or replacement (MVR). While each procedure boasts its merits, doubt remains as to which type of surgery is superior.MethodsWe searched PubMed, Scopus, Web of Science, and Cochrane literature databases for studies comparing MVR and MVr in mitral valve IE. Any randomized controlled trial (RCT) or observational studies that compare MVR vs. MVr in mitral valve IE were eligible. Our dichotomous outcomes were extracted in the form of event and total, and risk and hazard ratio (RR)(HR) with 95% confidence interval (CI) and were pooled and calculated using RevMan 5.0.ResultsOur study included 23 studies with a total population of 11,802 patients. Compared to MVR, MVr had statistically significant lower risks of both early mortality with RR [0.44; 95% CI, 0.38–0.51; p < 0.001] and long-term follow-up mortality with HR [0.70; 95% CI, 0.58–0.85; p = 0.0004]. Moreover, MVr was associated with a statistically significant lower risk of IE recurrence with RR [0.43; 95% CI, 0.32–0.58; p < 0.001]; however, no statistically significant differences between both groups in terms of re-operations with RR [0.83; 95% CI, 0.41–1.67; p = 0.60].ConclusionOur results suggest that MVr was superior in terms of in-hospital mortality, long-term survival, and risk of recurrence without significance in valve reoperation. Therefore, MVr is appropriate as a primary treatment choice and should be considered whenever possible in most IE patients.

Heart Valve Involvement (Mitral Valve Regurgitation) Caused by Libman–Sacks Endocarditis in Systemic Lupus Erythematosus : A Case Report and Review of the Literature

Libman–Sacks (LS) endocarditis is one of the most common cardiac manifestations of both systemic lupus erythematosus (SLE) and the antiphospholipid syndrome (APS). We report a case of mitral valve replacement for mitral regurgitation (MR) caused by Libman-Sacks endocarditis in young patient with systemic lupus erythematosus (SLE). In conclusion, Although typically mild and asymptomatic, the disease can lead to serious complications, including superimposed bacterial endocarditis, thromboembolic events, and severe valvular regurgitation and/or stenosis requiring surgery.

2-Year Clinical and Echocardiography Follow-Up of Transcatheter Mitral Valve Replacement With the Transapical Intrepid System

BackgroundThirty-day outcomes with the investigational Intrepid transapical (TA) transcatheter mitral valve replacement (TMVR) system have previously demonstrated good technical success, but longer-term outcomes in larger cohorts need to be evaluated. ObjectivesThe authors sought to evaluate the 2-year safety and performance of the Intrepid TA-TMVR system in patients with symptomatic, ≥moderate-severe mitral regurgitation (MR) and high surgical risk. MethodsPatient eligibility was determined by local heart teams and approved by a central screening committee. Clinical events were adjudicated by an independent clinical events committee. Echocardiography was evaluated by an independent core laboratory. ResultsThe cohort included 252 patients that were enrolled at 58 international sites before February 2021 as part of the global Pilot Study (n = 95) or APOLLO trial (primary cohort noneligible + TA roll-ins, n = 157). Mean age was 74.2 years, mean STS-PROM was 6.3%, 60.3% were male, and 80.6% were in NYHA functional class III/IV. Most presented with secondary MR (70.1%), and nearly all had ≥moderate-severe MR (98.4%). All-cause mortality was 13.1% (30-day), 27.3% (1-year), and 36.2% (2-year). The 30-day ≥major bleeding event rate was 22.3%. Heart failure rehospitalization was 9.6% (30-day) and 36.2% (2-year). At 2 years, >50% of patients were alive with improvement in NYHA functional class (82.1%, class I/II), and all patients with available echocardiograms had ≤mild MR. ConclusionsThis analysis represents the largest reported TA-TMVR experience with the longest follow-up in high-risk ≥moderate-severe MR patients. Early mortality and heart failure rehospitalizations were significant, exacerbated by early TA-related bleeding events; however, meaningful improvements in clinical outcomes and marked reductions in MR severity were observed through 2 years.

Long-Term Outcomes of Bioprosthetic Valves in the Mitral Position: A Pooled Meta-Analysis of Reconstructed Time-to-Event Individual Patient Data

ObjectivesBioprosthetic MVR use is on the rise, but data regarding long term durability is lacking. We sought to perform a reconstructed individual patient data meta-analysis from published Kaplan Meier curves to ascertain survival, freedom from valve degeneration and reoperation in studies published since 2010. We explored the effects of age and valve type (bovine pericardial or porcine valve) on outcomes. MethodsWe searched MEDLINE, OVID, Embase and Cochrane CENTRAL for studies reporting at least 3 years of follow-up after bMVR and published since 2010. The ROBINS-I tool was used to assess methodological quality. Kaplan Meier curves were digitized to extract individual patient data and reconstructed estimates for overall survival, freedom from SVD and freedom from re-operation. Results20 studies (16465 patients) were included. 9 studies reported on porcine valves, 6 on bovine and 7 did not specify the valve type. Overall survival after bMVR at 15 years was 40% (CI 38%-42%), freedom from re-operation at 15 years was 79% (CI 76%-82%) and freedom from structural valve degeneration at 15 years was 64% (58%-70%). Freedom from SVD was improved in the 70+ age group (93% up to 25 years, HR 6.6(2.5-17) for 18-59 VS >70, p<0.0001). There was no difference in valve durability or survival between bovine pericardial or porcine valves. ConclusionIn this meta-analysis patients of receiving bioprosthetic mitral valve replacement using newer generation valves, the inverse relationship between age and SVD was re-iterated in the 70+ age group. Prosthesis type made no difference in outcomes.