TY - JOUR

T1 - Transcatheter mitral valve replacement after surgical repair or replacement

T2 - comprehensive midterm evaluation of valve-in-valve and valve-in-ring implantation from the VIVID registry

AU - Simonato, Matheus

AU - Whisenant, Brian

AU - Ribeiro, Henrique Barbosa

AU - Webb, John G.

AU - Kornowski, Ran

AU - Guerrero, Mayra

AU - Wijeysundera, Harindra

AU - Søndergaard, Lars

AU - de Backer, Ole

AU - Villablanca, Pedro

AU - Rihal, Charanjit

AU - Eleid, Mackram

AU - Kempfert, Jörg

AU - Unbehaun, Axel

AU - Erlebach, Magdalena

AU - Casselman, Filip

AU - Adam, Matti

AU - Montorfano, Matteo

AU - Ancona, Marco

AU - Saia, Francesco

AU - Ubben, Timm

AU - Meincke, Felix

AU - Napodano, Massimo

AU - Codner, Pablo

AU - Schofer, Joachim

AU - Pelletier, Marc

AU - Cheung, Anson

AU - Shuvy, Mony

AU - Palma, José Honório

AU - Gaia, Diego Felipe

AU - Duncan, Alison

AU - Hildick-Smith, David

AU - Veulemans, Verena

AU - Sinning, Jan Malte

AU - Arbel, Yaron

AU - Testa, Luca

AU - de Weger, Arend

AU - Eltchaninoff, Helene

AU - Hemery, Thibault

AU - Landes, Uri

AU - Tchetche, Didier

AU - Dumonteil, Nicolas

AU - Rodés-Cabau, Josep

AU - Kim, Won Keun

AU - Spargias, Konstantinos

AU - Kourkoveli, Panagiota

AU - Ben-Yehuda, Ori

AU - Teles, Rui Campante

AU - Barbanti, Marco

AU - Fiorina, Claudia

AU - Thukkani, Arun

AU - Mackensen, G. Burkhard

AU - Jones, Noah

AU - Presbitero, Patrizia

AU - Petronio, Anna Sonia

AU - Allali, Abdelhakim

AU - Champagnac, Didier

AU - Bleiziffer, Sabine

AU - Rudolph, Tanja

AU - Iadanza, Alessandro

AU - Salizzoni, Stefano

AU - Agrifoglio, Marco

AU - Nombela-Franco, Luis

AU - Bonaros, Nikolaos

AU - Kass, Malek

AU - Bruschi, Giuseppe

AU - Amabile, Nicolas

AU - Chhatriwalla, Adnan

AU - Messina, Antonio

AU - Hirji, Sameer A.

AU - Andreas, Martin

AU - Welsh, Robert

AU - Schoels, Wolfgang

AU - Hellig, Farrel

AU - Windecker, Stephan

AU - Stortecky, Stefan

AU - Maisano, Francesco

AU - Stone, Gregg W.

AU - Dvir, Danny

N1 - Publisher Copyright: © 2020 American Heart Association, Inc.

PY - 2021

Y1 - 2021

N2 - BACKGROUND: Mitral valve-in-valve (ViV) and valve-in-ring (ViR) are alternatives to surgical reoperation in patients with recurrent mitral valve failure after previous surgical valve repair or replacement. Our aim was to perform a large-scale analysis examining midterm outcomes after mitral ViV and ViR. METHODS: Patients undergoing mitral ViV and ViR were enrolled in the Valve-in-Valve International Data Registry. Cases were performed between March 2006 and March 2020. Clinical endpoints are reported according to the Mitral Valve Academic Research Consortium (MVARC) definitions. Significant residual mitral stenosis (MS) was defined as mean gradient ≥10 mmHg and significant residual mitral regurgitation (MR) as ≥ moderate. RESULTS: A total of 1079 patients (857 ViV, 222 ViR; mean age 73.5±12.5 years; 40.8% male) from 90 centers were included. Median STS-PROM score 8.6%; median clinical follow-up 492 days (interquartile range, 76-996); median echocardiographic follow-up for patients that survived 1 year was 772.5 days (interquartile range, 510-1211.75). Four-year Kaplan-Meier survival rate was 62.5% in ViV versus 49.5% for ViR (P<0.001). Mean gradient across the mitral valve postprocedure was 5.7±2.8 mmHg (≥5 mmHg; 61.4% of patients). Significant residual MS occurred in 8.2% of the ViV and 12.0% of the ViR patients (P=0.09). Significant residual MR was more common in ViR patients (16.6% versus 3.1%; P<0.001) and was associated with lower survival at 4 years (35.1% versus 61.6%; P=0.02). The rates of Mitral Valve Academic Research Consortium-defined device success were low for both procedures (39.4% total; 32.0% ViR versus 41.3% ViV; P=0.01), mostly related to having postprocedural mean gradient ≥5 mmHg. Correlates for residual MS were smaller true internal diameter, younger age, and larger body mass index. The only correlate for residual MR was ViR. Significant residual MS (subhazard ratio, 4.67; 95% CI, 1.74-12.56; P=0.002) and significant residual MR (subhazard ratio, 7.88; 95% CI, 2.88-21.53; P<0.001) were both independently associated with repeat mitral valve replacement. CONCLUSIONS: Significant residual MS and/or MR were not infrequent after mitral ViV and ViR procedures and were both associated with a need for repeat valve replacement. Strategies to improve postprocedural hemodynamics in mitral ViV and ViR should be further explored.

AB - BACKGROUND: Mitral valve-in-valve (ViV) and valve-in-ring (ViR) are alternatives to surgical reoperation in patients with recurrent mitral valve failure after previous surgical valve repair or replacement. Our aim was to perform a large-scale analysis examining midterm outcomes after mitral ViV and ViR. METHODS: Patients undergoing mitral ViV and ViR were enrolled in the Valve-in-Valve International Data Registry. Cases were performed between March 2006 and March 2020. Clinical endpoints are reported according to the Mitral Valve Academic Research Consortium (MVARC) definitions. Significant residual mitral stenosis (MS) was defined as mean gradient ≥10 mmHg and significant residual mitral regurgitation (MR) as ≥ moderate. RESULTS: A total of 1079 patients (857 ViV, 222 ViR; mean age 73.5±12.5 years; 40.8% male) from 90 centers were included. Median STS-PROM score 8.6%; median clinical follow-up 492 days (interquartile range, 76-996); median echocardiographic follow-up for patients that survived 1 year was 772.5 days (interquartile range, 510-1211.75). Four-year Kaplan-Meier survival rate was 62.5% in ViV versus 49.5% for ViR (P<0.001). Mean gradient across the mitral valve postprocedure was 5.7±2.8 mmHg (≥5 mmHg; 61.4% of patients). Significant residual MS occurred in 8.2% of the ViV and 12.0% of the ViR patients (P=0.09). Significant residual MR was more common in ViR patients (16.6% versus 3.1%; P<0.001) and was associated with lower survival at 4 years (35.1% versus 61.6%; P=0.02). The rates of Mitral Valve Academic Research Consortium-defined device success were low for both procedures (39.4% total; 32.0% ViR versus 41.3% ViV; P=0.01), mostly related to having postprocedural mean gradient ≥5 mmHg. Correlates for residual MS were smaller true internal diameter, younger age, and larger body mass index. The only correlate for residual MR was ViR. Significant residual MS (subhazard ratio, 4.67; 95% CI, 1.74-12.56; P=0.002) and significant residual MR (subhazard ratio, 7.88; 95% CI, 2.88-21.53; P<0.001) were both independently associated with repeat mitral valve replacement. CONCLUSIONS: Significant residual MS and/or MR were not infrequent after mitral ViV and ViR procedures and were both associated with a need for repeat valve replacement. Strategies to improve postprocedural hemodynamics in mitral ViV and ViR should be further explored.

KW - Heart valve disease

KW - Hemodynamics

KW - Mitral valve

KW - Mitral valve insufficiency

KW - Mitral valve stenosis

U2 - 10.1161/CIRCULATIONAHA.120.049088

DO - 10.1161/CIRCULATIONAHA.120.049088

M3 - Journal article

C2 - 32975133

AN - SCOPUS:85100069320

VL - 143

SP - 104

EP - 116

JO - Circulation

JF - Circulation

SN - 0009-7322

M1 - 49088

ER -