Comparative Analysis of Transcatheter Mitral Valve Replacement versus Redo-Surgical Mitral Valve Replacement: A Systematic Review and Meta Analysis
Recommended Citation
Shaukat MT, Rehman W, Rehman AU, Mohsin A, Rahman SU, Imran H, Qureshi MA, Abbott J, Ehsan A, Sellke F. Comparative Analysis of Transcatheter Mitral Valve Replacement versus Redo-Surgical Mitral Valve Replacement: A Systematic Review and Meta Analysis. Circulation 2024; 150(Suppl 1).
Document Type
Conference Proceeding
Publication Date
11-11-2024
Publication Title
Circulation
Abstract
Background: Transcatheter mitral valve replacement (TMVR) has emerged as a promising alternative to conventional redo-surgical intervention in patients presenting with mitral valve prosthesis failure. We conducted a meta-analysis to delineate efficacy and safety of transcatheter mitral valve replacement (TMVR), encompassing both valve-in-valve (ViV) and valve-in-ring (ViR) procedures, compared to redosurgical mitral valve replacement (SMVR). Aim: The primary aim of our meta-analysis was to investigate the early clinical outcomes following either ViV/ViR TMVR or SMVR. Methods: PubMed/MEDLINE, Cochrane Library, and clinicaltrials.gov were systematically searched according to predefined inclusion and exclusion criteria. Several efficacy and safety outcomes were pooled and reported as risk ratios (RRs) with 95% confidence intervals (CIs). Results: Fourteen retrospective cohort studies (patients=18,519) were evaluated in this analysis. Compared with redo-SMVR for mitral valve prosthesis failure, TMVR exhibited lower in-hospital mortality (OR=0.69; 95% CI 0.56-0.86; p<0.01). Moreover, stroke (OR=0.46; 95% CI 0.31-0.68; p=0.05), renal dysfunction (OR=0.49; 95% CI 0.38-0.63; p<0.01), need for pacemaker implantation (OR=0.28; 95% CI 0.23-0.34; p<0.01), major cardiac complications (OR=0.43; 95% CI 0.32-0.59; p<0.01), length of ICU stay (OR=-2.11; 95% CI -2.82 - -1.39; p< 0.01), and need for exploration for bleeding (OR=0.23; 95% CI 0.17-0.30; p<0.01) also revealed significant improvements in the TMVR cohort. To minimize heterogeneity, we performed subgroup analysis for in-hospital mortality, which remained significant (OR=0.42; 95% CI 0.34-0.51; P< 0.01) on propensity matching. Conversely, paravalvular leak (OR=22.12; 95% CI 2.81-174.16; p=0.003) generated results favoring SMVR. There was negligible and nonsignificant difference in mean mitral valve gradient (MD: -0.01; 95% CI: -0.57 to 0.5; P =0.97), 30-day mortality (OR: 0.86; 95% CI: 0.48-1.53; P = 0.60), and 1-year mortality (OR: 1.05; 95% CI: 0.68-1.61; P = 0.83) between the two groups. Conclusion: In patients experiencing mitral valve prosthesis failure, TMVR offers an efficacious, safe, and less invasive alternative to SMVR. However, the risk of paravalvular leak requires careful monitoring. (Figure Presented).
Volume
150
Issue
Suppl 1
