3-Year Outcomes of Mitral Valve-in-Valve Therapy Using Balloon-Expandable Transcatheter Valves in the United States

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2025-06-09 DOI:10.1016/j.jcin.2025.03.017

Mackram F. Eleid MD , Amar Krishnaswamy MD , Samir Kapadia MD , Pradeep Yadav MD , Vivek Rajagopal MD , Raj Makkar MD , Curtiss Stinis MD , Stanley Chetcuti MD , Andrew Morse MD , Tiberio Frisoli MD , Antonio H. Frangieh MD , Amr E. Abbas MD , Brian Whisenant MD , William W. O'Neill MD , Mayra E. Guerrero MD , Evelio Rodriguez MD , Susheel Kodali MD , Gorav Ailawadi MD , Charanjit S. Rihal MD

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引用次数: 0

Abstract

Background

Mitral valve-in-valve (MViV) is a safe and effective therapy for severe bioprosthetic mitral degeneration; however, longer-term outcomes are not well defined.

Objectives

This study aimed to evaluate 3-year outcomes following MViV.

Methods

Outcomes of all-cause mortality, stroke, and reintervention were collected in patients undergoing transseptal MViV with the SAPIEN 3 valve family for failed surgical bioprostheses from June 2015 to March 2024 in the TVT (Transcatheter Valve Therapy) Registry, and Centers for Medicare and Medicaid Services data linkage was performed. Kaplan-Meier and Cox proportional hazards analysis was performed according to Society of Thoracic Surgeons (STS) score and procedure status.

Results

A total of 5,971 patients (age 72.9 ± 11.4 years, 57.9% [n = 3457 of 5,971] female) underwent MViV. Low (<4), intermediate (4-8), and high (>8) STS scores were present in 23.5% (n = 1,310 of 5,585), 35.1% (n = 1,960 of 5,585) and 41.5% (n = 2,315 of 5,585) of patients, respectively. Median follow-up duration was 377 days (Q1-Q3: 57-698 days). Mortality at 3 years was greatest in high STS score and nonelective procedures, while mortality was lowest in low STS score patients and elective procedures. Stroke rates at 3 years were comparable except between low and high STS groups. Mitral valve reintervention during 3 years of follow-up was uncommon in all groups.

Conclusions

Three-year survival after MViV is highest in low STS scores and elective procedures, whereas survival was significantly lower in high STS scores and nonelective procedures. These findings emphasize the importance of early identification and treatment of patients who may benefit from MViV. Reintervention rates at 3 years are low regardless of STS score.

查看原文本刊更多论文

在美国使用球囊可扩张的经导管瓣膜进行二尖瓣中瓣治疗的3年结果

二尖瓣内瓣（MViV）是一种安全有效的治疗重度生物假体二尖瓣变性的方法；然而，长期结果尚不明确。目的本研究旨在评估MViV术后3年的预后。方法收集2015年6月至2024年3月在TVT（经导管瓣膜治疗）登记处接受SAPIEN 3瓣膜家族经间隔MViV治疗失败的外科生物假体患者的全因死亡率、卒中和再干预结果，并进行医疗保险和医疗补助服务中心的数据链接。根据胸外科学会（Society of Thoracic Surgeons， STS）评分和手术状态进行Kaplan-Meier和Cox比例风险分析。结果5971例患者（年龄72.9±11.4岁）行MViV手术，其中57.9% （n = 3457 / 5971）为女性。低（<4）、中（>8）和高（>8） STS评分分别出现在23.5% （n = 1310 / 5585）、35.1% （n = 1960 / 5585）和41.5% （n = 2315 / 5585）的患者中。中位随访时间为377天（Q1-Q3: 57-698天）。STS评分高和非选择性手术的3年死亡率最高，而STS评分低和选择性手术的3年死亡率最低。除了低STS组和高STS组之间，3年卒中发生率具有可比性。3年随访期间二尖瓣再介入在所有组中均不常见。结论：低STS评分和选择性手术的MViV术后3年生存率最高，而高STS评分和非选择性手术的生存率明显较低。这些发现强调了早期识别和治疗可能受益于MViV的患者的重要性。无论STS评分如何，3年后的再干预率都很低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.