Valve-in-valve transcatheter mitral valve replacement (ViV TMVR) may provide value as an effective alternative to redo surgical mitral valve replacement (SMVR) in patients with mitral prosthesis dysfunction, according to new findings published in the Journal of the American Heart Association.
The study’s authors explored National Inpatient Sample data from September 2015 to December 2018, tracking 495 patients who underwent ViV TMVR and 2,260 patients who underwent redo SMVR.
ViV TMVR patients had a median age of 77 years old, and 52.5% were women. Redo SMVR patients had a median age of 68 years old, and 51.1% were women. Both cohorts were at least 74% white. While congestive heart failure, chronic obstructive pulmonary disease, hypertension and renal failure were more common among ViV TMVR patients, atrial fibrillation and coagulopathy were more common among redo SMVR patients.
Overall, adjusted mortality and perioperative complications were both lower among patients undergoing ViV TMVR. Blood transfusions, for example, were much less common (7.6% vs. 38%) when patients underwent ViV TMVR instead of redo SMVR.
Redo SMVR was also associated with a lower cost of care ($52,579 vs. $57,172) and shorter length of stay (3 days vs. 10 days).
“ViV TMVR may be a viable option for some patients with mitral prosthesis dysfunction,” wrote lead author Muhammad Zia Khan, MD, MS, of the West Virginia University Heart and Vascular Institute, and colleagues. “Studies evaluating long‐term outcomes and durability of ViV TMVR are needed.”
The team also emphasized the importance of making treatment decisions on a case-by-case basis.
“Patient selection for either ViV TMVR or redo SMVR should be individualized to optimize outcomes,” the authors wrote. “Heart teams should also acknowledge the lack of data on long‐term outcomes and durability of ViV TMVR.”
Read the full analysis here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.