When bioprosthetic mitral valves fail: Redo surgery bests transcatheter treatment after 5 years
When patients present with a failing bioprosthetic mitral valve, redo surgical mitral valve replacement (SMVR) is associated with a better long-term survival rate than transcatheter mitral valve-in-valve (mViV), according to new data published in The Annals of Thoracic Surgery.[1]
Researchers explored data from more than 200 patients treated at one of two high-volume facilities from 2004 to 2023. A total of 90 patients with a mean age of 66 years old underwent redo SMVR, and another 139 patients with a mean age of 68.7 years old underwent mViV.
While short-term outcomes were comparable, and mViV was linked to shorter hospitalizations, the all-cause mortality rates after five years were 20.3% for redo SMVR and 40.9% for mViV. Mean mitral gradients were also significantly lower for patients treated with redo SMVR.
Freedom from mitral valve reintervention, meanwhile, was similar for these two patient groups.
“Although transcatheter valve-in-valve procedures offer clear short-term advantages, our findings suggest that surgery provides greater durability and improved long-term survival in appropriately selected patients,” lead author S. Christopher Malaisrie, MD, a professor of surgery at Northwestern Medicine, said in a statement. “Survival outcomes between the two groups began to diverge after one year and continued to widen over time.”
Malaisrie et al. did point to certain limitations of their study, including the smaller sample size and the fact that the follow-up period stops at five years. Even with these things in mind, though, the group wrote that this analysis supports existing industry-wide recommendations to choose redo SMVR when possible in low-risk patients with longer life expectancies.
Click here to read the full study in The Annals of Thoracic Surgery, the flagship journal of The Society of Thoracic Surgeons.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.