Mitral Valve-in-Valve: Who Lives Longer and Why?

Researchers led by Mackram F. Eleid, MD, of Mayo Clinic, Rochester, Minnesota, conducted a study evaluating the three-year survival outcomes from patients undergoing transseptal MViV with the SAPIEN 3 valve family for failed surgical bioprostheses.

The study included data from 5,971 patients with low (23.5%), intermediate (35.1%), or high (41.5%) Society for Thoracic Surgeons (STS) scores. Mean STS scores were 2.8, 5.9, and 12.5, respectively, in the low-, intermediate-, and high-risk groups.

The mortality rates were highest among patients with high STS scores and those who had undergone nonelective procedures, and lowest among those with low STS scores and had undergone elective procedures. Overall, in-hospital mortality occurred in 3.1% of patients; in the high-risk group, in-hospital mortality was 5.3% compared with 1.8% in the intermediate- and low-risk groups. Hospital length of stay was also significantly longer for patients in the high-risk group.

With a median follow-up of 377 days, the overall 3-year mortality was 31.9%; in the high-risk group, it was 44.5% compared with 23.3% for the intermediate-risk group and 15.8% for the low-risk group.

Undergoing an elective procedure was associated with a lower three-year mortality compared with a non-elective procedure (28.2% vs 43.3%; hazard ratio=0.51; 95% CI, 0.45-0.58; P<.0001).

“Given the consistency of procedural results despite the risk profile, it is likely that the higher mortality rate was driven by a higher frequency of comorbidities, including more advanced age, kidney and lung disease, and more advanced heart failure with concomitant valvular heart disease,” the researchers wrote. “Non-elective procedures and patients with advanced heart failure presentation and multiorgan dysfunction had the highest 3-year mortality, emphasizing the importance of early identification and treatment of patients who may benefit from MViV.”