Comparison of Clinical and Echocardiographic Outcomes After Surgical Redo Mitral Valve Replacement and Transcatheter Mitral Valve-in-Valve Therapy

Norihiko Kamioka, Vasilis Babaliaros, Michael Andrew Morse, Tiberio Frisoli, Stamatios Lerakis, Jose Miguel Iturbe, Jose Binongo, Frank Corrigan, Altayyeb Yousef, Patrick Gleason, John A. Wells, Hope Caughron, Andy Dong, Evelio Rodriguez, Bradley Leshnower, William O'Neill, Gaetano Paone, Marvin Eng, Robert Guyton, Peter C. BlockAdam Greenbaum

Research output: Contribution to journalArticlepeer-review

53 Scopus citations


Objectives: There are minimal data regarding clinical outcomes and echocardiographic findings after transcatheter mitral valve-in-valve replacement (TMVR) compared with redo surgical mitral valve replacement (SMVR). Background: TMVR therapy has emerged as therapy for a degenerated bioprosthetic valve failure. Methods: The authors retrospectively identified patients with degenerated mitral bioprostheses who underwent redo SMVR or TMVR at 3 U.S. institutions. The authors compared clinical and echocardiographic outcomes of patients who had TMVR with those of patients who underwent redo SMVR. Results: Sixty-two patients underwent TMVR and 59 patients underwent SMVR during the study period. Mean age and the Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) scores were significantly higher in patients with TMVR than in those with SMVR (age 74.9 ± 9.4 years vs. 63.7 ± 14.9 years; p < 0.001; STS PROM 12.7 ± 8.0% vs. 8.7 ± 10.1%; p < 0.0001). Total procedure time, intensive care unit hours, and post-procedure length of stay were all significantly shorter in the TMVR group. There was no difference in mortality at 1 year between the 2 groups (TMVR 11.3% vs. SMVR 11.9%; p = 0.92). Mean mitral valve pressure gradient and the grade of mitral regurgitation (MR) were similar between the TMVR group and the SMVR group (mitral valve pressure gradient 7.1 ± 2.5 mm Hg vs. 6.5 ± 2.5 mm Hg; p = 0.42; MR [≥moderate] 3.8% vs. 5.6%; p = 1.00) at 30 days. At 1 year, the mitral valve pressure gradient was higher in the TMVR group (TMVR 7.2 ± 2.7 vs. SMVR 5.5 ± 1.8; p = 0.01), although there was no difference in the grade of MR. Conclusions: Despite the higher STS PROM in TMVR patients, there was no difference in 1-year mortality between the TMVR and SMVR groups. Echocardiographic findings after TMVR were similar to SMVR at 30 days. There was a statistically significant difference in mitral gradient at 1 year, though this is likely not clinically important. TMVR may be an alternative to SMVR in patients with previous mitral bioprosthetic valves.

Original languageEnglish (US)
Pages (from-to)1131-1138
Number of pages8
JournalJACC: Cardiovascular Interventions
Issue number12
StatePublished - Jun 25 2018


  • mitral valve replacement
  • redo
  • valve-in-valve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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