Promising outcomes reported for transcatheter mitral valve-in-valve replacement

Transcatheter mitral valve-in-valve (MViV) replacement with the SAPIEN 3 prosthesis is associated with positive outcomes after one year, according to new findings published in JAMA Cardiology. Also, transseptal MViV was found to provide more value than transapical MViV.

The authors tracked more than 1,500 high-risk patients who underwent SAPIEN 3 MViV at one of 295 different hospitals from June 2015 to July 2019. The mean patient age was 73.3 years old. All data came from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.

Overall, transcatheter MViV had a procedural technical success rate of 96.8%. All-cause mortality was 5.4% after 30 days and 16.7% after one year. One-year all-cause mortality was 15.8% for transseptal MViV and 21.7% for transapical MViV. The mean STS score for mortality after 30 days was 11.1%.

Complications were rare with MViV, but did occur. Such issues included cardiac perforation (1.1% of patients), left ventricular outflow tract obstruction (0.9%), stroke (0.7%) and device embolization (0.3%).

“Transcatheter MViV using the SAPIEN 3 transcatheter heart valve was associated with high technical success, few complications and 30-day mortality rates markedly lower than predicted by the STS score,” wrote lead author Brian Whisenant, MD, Intermountain Medical Center in Salt Lake City, and colleagues. “Most patients experienced clinically important improvement in heart failure symptoms and quality of life by 30 days that were maintained at one year.”

Whisenant et al. also noted that anticoagulation medication is recommended, though specific clinical guidelines related to MViV and anticoagulation don’t yet exist. Ultimately, the group recommends following guidelines for surgical bioprosthetic valves.

“Additional studies are indicated to define the long-term durability of transcatheter mitral valves and the role of anticoagulants, including direct oral anticoagulants, to prevent MViV thrombosis,” the authors wrote. “Anticoagulation should be discussed with patients considering MViV replacement.”

The full study from JAMA Cardiology is available here.