麻豆传媒

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 麻豆传媒. 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.

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