Pooled Analysis of Valve-in-Valve and Valve-in-Ring Transcatheter Mitral Valve Replacement Using the SAPIEN Valve.
Chloe Kharsa, Sahar Samimi, Ankit Agrawal et al.
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In 30 seconds
This systematic review and random-effects meta-analysis compared SAPIEN valve-in-valve (ViV) with valve-in-ring (ViR) transcatheter mitral valve replacement in patients with failed mitral bioprostheses or prior surgical mitral repair. Eight studies included 1,947 patients. Thirty-day mortality did not differ significantly between groups (OR 0.70 [95% CI 0.47-1.05]). ViV-TMVR was associated with lower rates of left ventricular outflow tract obstruction, reintervention, and acute kidney injury; stroke, major bleeding, device embolization, and in-hospital mortality were comparable.
Key findings
- Thirty-day mortality was not significantly different between ViV-TMVR and ViR-TMVR (OR: 0.70 [95% CI: 0.47-1.05]; I 2 =0%).
- ViV-TMVR was associated with lower left ventricular outflow tract obstruction (OR: 0.30 [95% CI: 0.18-0.51]).
- Reintervention was less frequent with ViV-TMVR (OR: 0.19 [95% CI: 0.13-0.30]).
- ViV-TMVR was associated with lower acute kidney injury (OR: 0.51 [95% CI: 0.29-0.90]); stroke, major bleeding, and device embolization did not differ significantly.
Why it matters
The comparison highlights that procedural anatomy may be relevant to outcomes after transcatheter mitral valve replacement. Although mortality and several major complications were similar, the lower observed rates of outflow tract obstruction, reintervention, and acute kidney injury with ViV-TMVR may help frame risk assessment when considering these procedures.
What to keep in mind
The analysis pooled eight studies, and patients undergoing ViV-TMVR were older and had greater baseline comorbidity, limiting direct comparison between groups.