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American Heart Association

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Final ID: MDP661

Comparative Analysis of Transcatheter Mitral Valve Replacement versus Redo-Surgical Mitral Valve Replacement: A Systematic Review and Meta Analysis

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.
  • Shaukat, Muhammad Talha  ( King Edward Medical University , Lahore , Pakistan )
  • Sellke, Frank  ( Brown Medical School , Providence , Rhode Island , United States )
  • Rehman, Wania  ( King Edward Medical University , Lahore , Pakistan )
  • Rehman, Aqeeb Ur  ( University of Alabama , Birmingham , Alabama , United States )
  • Mohsin, Aleenah  ( Brown University , Providence , Rhode Island , United States )
  • Rahman, Saad Ur  ( Carle Health , Urbana , Illinois , United States )
  • Imran, Hafiz  ( RHODE ISLAND HOSPITAL , Providence , Rhode Island , United States )
  • Qureshi, Muhammad Ahmad  ( Henry Ford Jackson Hospital , Jackson , Michigan , United States )
  • Abbott, Jinnette  ( RHODE ISLAND HOSPITAL , Providence , Rhode Island , United States )
  • Ehsan, Afshin  ( Rhode Island Hospital , Providence , Rhode Island , United States )
  • Author Disclosures:
    Muhammad Talha Shaukat: DO NOT have relevant financial relationships | Frank Sellke: DO have relevant financial relationships ; Ownership Interest:Xm therapeutics:Active (exists now) | Wania Rehman: DO NOT have relevant financial relationships | Aqeeb Ur Rehman: DO NOT have relevant financial relationships | Aleenah Mohsin: DO NOT have relevant financial relationships | Saad Ur Rahman: DO NOT have relevant financial relationships | Hafiz Imran: DO NOT have relevant financial relationships | Muhammad Ahmad Qureshi: DO NOT have relevant financial relationships | Jinnette Abbott: DO have relevant financial relationships ; Consultant:Abbott:Active (exists now) ; Consultant:recor :Active (exists now) ; Research Funding (PI or named investigator):Shockwave:Active (exists now) ; Research Funding (PI or named investigator):Med Allinace:Active (exists now) ; Research Funding (PI or named investigator):Boston Scientific:Active (exists now) ; Consultant:Penumbra:Active (exists now) ; Consultant:Medtronic:Active (exists now) | Afshin Ehsan: DO NOT have relevant financial relationships
Meeting Info:

Scientific Sessions 2024

2024

Chicago, Illinois

Session Info:

Deep Dive into Transcatheter Mitral Valve Therapies

Saturday, 11/16/2024 , 12:50PM - 02:15PM

Moderated Digital Poster Session

More abstracts from these authors:
Analysing the Global Landscape of Hypertension-Related Aortic Aneurysm Mortality: Insights from 31-Year Analysis of Global Burden Of Disease 2021

Shaukat Muhammad Talha, Rehman Wania, Mohsin Aleenah, Rehman Aqeeb Ur, Rahman Saad Ur, Qureshi Muhammad Ahmad, Mohsin Ali

Global And Regional Burden Of Alcoholic Cardiomyopathy From 1980 To 2021: An Analysis Of Global Burden Of Disease (GBD) Study 2021

Rehman Wania, Shaukat Muhammad Talha, Rehman Aqeeb Ur, Mohsin Aleenah, Rahman Saad Ur, Abbott Jinnette, Nanda Navin

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