Clinical Edge

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Mitral valve-in-valve improves outcomes with low mortality

Key clinical point: The transseptal SAPIEN 3 mitral valve-in-valve was associated with few complications and low mortality in high-risk patients.

Major finding: Use of a transcatheter mitral valve-in-valve yielded significant improvements in heart failure after 1 year compared to baseline (9.7% vs. 87.1%), with mortality rates of 5.4% at 30 days and 16.7% at 1 year.

Study details: The data come from 1,529 adults who underwent mitral valve replacement.

Disclosures: The study received no outside funding. Lead author Dr. Whisenant disclosed fees from Edwards Lifesciences outside the submitted work. Edward Lifesciences manufactures the valve replacement used in the study.

Commentary

“Reoperation of failed bioprosthetic mitral valve involves significant risks to patients, and transcatheter mitral valve-in-valve (MViV) has been shown to be a viable alternative to patients. This prospective cohort study of in the Society of Thoracic Surgeons (STS)/American College of Cardiology Transcatheter Valve Therapy Registry from June 2015 to July 2019 analyzed efficacy and safety of MViV involving 1,529 patients. This study demonstrated an extremely high procedural technical success rate (96.8%). All-cause mortality was 5.4% at 30 days and 16.7% at 1 year, which is markedly lower than predicted by the STS score. Transseptal access was further associated with lower mortality than transapical access (15.8% vs 21.7%; P = 0.03). Furthermore, transcatheter MViV was associated with a significant improvement in heart failure symptoms (class III/IV New York Heart Association heart failure of 87.1% at baseline vs. 9.7% at 1 year). This study demonstrates that transcatheter MViV, especially if transseptal approach is feasible, should be strongly considered as an option for most patients with failed bioprosthetic mitral valve.”

Luke Kim, MD

Weill Cornell Medical College/New York Presbyterian Hospital

Citation:

Whisenant B et al. JAMA Cardiol. 2020 July 29. doi:10.1001/jamacardio.2020.2974.