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Surgery Setting 'Benchmark' for Mitral Valve-in-Valve Expectations

— In-hospital mortality of 6.1%, 1-year survival of 88% seen at one center

MedpageToday

Contemporary results with surgical mitral valve replacement for failed bioprosthetic valves set the bar for thinking about transcatheter valve-in-valve treatment, researchers said.

In one center's experience, redo surgical mitral valve replacements were associated with an in-hospital mortality rate of 6.1%, with postoperative new-onset atrial fibrillation observed in 27% of patients and 9.3% requiring re-exploration for bleeding.

Survival was 88% at 1 year to 72% at 5 years, 49% at 1o years, and 29% at 15 years, according to a poster at the of the American Association for Thoracic Surgery by Hoda Javadikasgari, MD, of the Cleveland Clinic, and colleagues.

"With advent of transcatheter valve-in-valve treatment for failed bioprosthetic mitral valves, it is necessary to establish a benchmark from surgical reintervention," which this study does, according to their poster presentation.

Death soon after re-replacement was more likely when patients went into surgery with a higher New York Heart Association class, renal dysfunction, and complete heart block. These factors may help pick out high-risk patients that may be good candidates for transcatheter therapies, the authors suggested.

The caveat is that there are no thresholds established yet, Javadikasgari told 鶹ý. Ultimately, she said, "long-term results of transcatheter valve-in-valve are unclear at this time. Therefore, we cannot consider it a replacement for surgery."

Of the 1,090 patients getting a second mitral valve replacement from 1990 to 2002 at Javadikasgari's institution, 462 had it done for bioprosthetic structural valve deterioration. The bulk of these cases were for regurgitation (81%) and stenosis (35%). Patients were excluded from the analysis if they had a paravalvular leak, endocarditis, or mitral valve reoperation during the reoperation hospital stay.

Javadikasgari and colleagues observed that the proportion of mitral valves getting explanted fell from 80% in 1990 to less than 50% in 2002 -- before it steadily rebounded through 2017.

In the long run, mortality after surgical valve redo replacement was associated with older age, higher number of cardiac operations, and prior MI in a patient.

  • author['full_name']

    Nicole Lou is a reporter for 鶹ý, where she covers cardiology news and other developments in medicine.

Disclosures

Javadikasgari disclosed no relevant conflicts of interest.

Primary Source

American Association for Thoracic Surgery meeting

Javadikasgari H, et al "Contemporary outcomes of mitral valve re-replacement for bioprosthetic structural valve deterioration: A benchmark for transcatheter valve-in-valve procedures" AATS 2018.