Abstract Body (Do not enter title and authors here): 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 redo-surgical 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.