Valve in valve Trancatheter Mitral Valve Replacement (ViV TMVR) vs. Redo Surgical Mitral Valve Replacement (SMVR) for degenerating bioprosthetic valves- A Meta-Analysis
Presenter
Salman Zahid, Rochester General Hospital, Rochester, NY
Salman Zahid1, Arslan Inayat2, Salman Khan3, Deepika Sarvepalli4, Asma Gilani5, Waqas Ullah, M.D.6, Muhammad Z Khan, MD7, Muhammad U Khan8, Sudarshan Balla, MD7 and M Chadi Alraies, MD, FSCAI9, (1)Rochester General Hospital, Rochester, NY, (2)Sisters of Charity Hospital Catholic Health, Buffalo, NY, (3)St Vincent Hospital, Toledo, OH, (4)Gunter Medical College, Guntur, India, (5)Khyber Girls Medical College, Peshawar, Pakistan, (6)Abington Jefferson Health, Abington, PA, (7)West Virginia University School Of Medicine, Morgantown, WV, (8)The West Virginia University School of Medicine, Morgantown, WV, (9)Detroit Medical Center Heart Hospital, Bloomfield , MI
Keywords: TEER/TMVR/Mitral Valve
Background
The data on outcomes for ViV TMVR vs. redo SMVR for degenerating bioprosthetic valves remains limited. Methods
The Pubmed, cochrane database and embase were queried for relevant articles. Data was analyzed using a random-effect model to calculate unadjusted odds ratio (OR). Results
A total of 260 patients, 132 in the ViV TMVR group and 128 in the redo SMVR group were included in the analysis. The ViV TMVR group had older patients with higher mean age compared to redo SMVR group (76.5±9 vs.66.1±10,p=<0.01). The comorbidity burden was greater in the TMVR group with higher proportion of patients having diabetes(22% vs. 12%,p=0.03), hypertension (68% vs. 52%,p=0.01) and dyslipidemia (57% vs.37%,p=<0.01) for ViV TMVR vs. Redo SMVR respectively. On pooled analysis, the major adverse cardiovascular events (OR: 0.40, 95% CI 0.24-0.66,p=<0.01) and major bleeding (OR: 0.40, 95% CI 0.17-0.95,p=0.04) were significantly lower for patients undergoing ViV TMVR compared to redo SMVR group respectively. However the odds for mortality (OR: 0.60, 95% CI 0.22-1.68,p=0.33) and stroke (OR: 0.30, 95% CI 0.07-1.27,p=0.68) were found comparable between the two groups. The hospital length of stay (LOS) was significantly lower for ViV TMVR when compared to redo SMVR group (7.9± 5.2 vs. 11.9± 6.5, p=<0.01). Conclusions
ViV TMVR has a better safety profile with lower odds of MACE and major bleeding when compared to redo SMVR for degenerating bioprosthetic valves. In terms of resource utilization, ViV TMVR has a significantly shorter hospital stay compared to conventional surgery. 