Transapical transcatheter mitral valve-in-valve implantation versus minimally invasive surgery for failed mitral bioprostheses

The aim of this study was to compare early outcomes and survival of patients undergoing minimally invasive mitral valve replacement through a right anterior minithoracotomy (MIMVR) versus patients undergoing transcatheter transapical mitral valve-in-valve (M-VIV) implantation for a failed mitral bioprostheses.From 2005 to 2015, 61 patients with a failed mitral bioprosthesis underwent either MIMVR ( n  = 40 patients, 65.6%) or M-VIV implantation ( n  = 21, 34.4%) at our institution. The groups were compared in terms of early outcomes and survival rates. Treatment selection bias was controlled by a propensity score and was included along with the comparison variable in the multivariable analyses of outcome.Patients with M-VIV implantation were older ( P  = 0.03), had more pulmonary hypertension ( P  = 0.02) and a higher EuroSCORE ( P  = 0.001). In-hospital mortality was 7.5% ( n  = 3) in the MIMVR group and 4.7% ( n  = 1) in the M-VIV group [odds ratio (OR) = 2.46; P  = 0.512]. Incidence of stroke was 12.5% ( n  = 5) in the MIMVR group vs 4.7% ( n  = 1) in the M-VIV group (OR = 0.887; P  = 0.935). No significant differences were noted in postprocedural complications, even after adjusting the results for the propensity score. M-VIV patients had shorter stays in the intensive care unit and in the hospital ( P  = 0.02). In the M-VIV group, 28% ( n  = 7) had less than mild paravalvular leakage, whereas no patients had mild paravalvular leakage in the MIMVR group ( P  < 0.001). Finally, the 2-year survival rates were 86 ± 1% vs 87 ± 1% in patients undergoing MIMVR compared with those undergoing M-VIV implantation, respectively ( P  = 0.1).In selected patients, M-VIV can be performed safely with results comparable with those of surgical therapy.