Transapical transcatheter mitral valve-in-valve implantation versus minimally invasive surgery for failed mitral bioprostheses

Abstract

Objectives: The aim of this study was to compare early outcomes and survival of patients undergoing minimally invasive mitral valve replacement through a right anterior minithoracotomy (MIMVR) versus patients undergoing transcatheter transapical mitral valve-in-valve (M-VIV) implantation for a failed mitral bioprostheses.

Methods: From 2005 to 2015, 61 patients with a failed mitral bioprosthesis underwent either MIMVR ( n = 40 patients, 65.6%) or M-VIV implantation ( n = 21, 34.4%) at our institution. The groups were compared in terms of early outcomes and survival rates. Treatment selection bias was controlled by a propensity score and was included along with the comparison variable in the multivariable analyses of outcome.

Results: Patients with M-VIV implantation were older ( P = 0.03), had more pulmonary hypertension ( P = 0.02) and a higher EuroSCORE ( P = 0.001). In-hospital mortality was 7.5% ( n = 3) in the MIMVR group and 4.7% ( n = 1) in the M-VIV group [odds ratio (OR) = 2.46; P = 0.512]. Incidence of stroke was 12.5% ( n = 5) in the MIMVR group vs 4.7% ( n = 1) in the M-VIV group (OR = 0.887; P = 0.935). No significant differences were noted in postprocedural complications, even after adjusting the results for the propensity score. M-VIV patients had shorter stays in the intensive care unit and in the hospital ( P = 0.02). In the M-VIV group, 28% ( n = 7) had less than mild paravalvular leakage, whereas no patients had mild paravalvular leakage in the MIMVR group ( P < 0.001). Finally, the 2-year survival rates were 86 ± 1% vs 87 ± 1% in patients undergoing MIMVR compared with those undergoing M-VIV implantation, respectively ( P = 0.1).

Conclusions: In selected patients, M-VIV can be performed safely with results comparable with those of surgical therapy.

Keywords: Minimally invasive valve surgery; Mitral valve; Transcatheter valve therapy.