Hisato Takagi1,2, Yosuke Hari1,2, Norikazu Kawai1, Tomo Ando3. 1. Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan. 2. Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan. 3. Department of Cardiology, Detroit Medical Center, Detroit, Michigan.
Abstract
OBJECTIVES: We performed a meta-analysis of transcatheter mitral valve implantation (TMVI) for deteriorated bioprosthetic valves (valve-in-valve [VIV]-TMVI) and/or failed annuloplasty rings (valve-in-ring [VIR]-TMVI), comparing observed early (30-day) mortality with predicted operative mortality. BACKGROUND: It remains unclear whether VIV/VIR-TMVI reduces mortality as compared with redo MVS. METHODS: MEDLINE and EMBASE were searched current through 24 July 2018 using Web-based search engines (PubMed and OVID) to identify studies including ≥10 patients undergoing VIV/VIR-TMVI. For each study, data regarding observed 30-day mortality and predicted operative mortality (Society of Thoracic Surgeons Predicted Risk of Mortality [STS-PROM]) were used to generate risk ratios (RRs) and 95% confidence intervals (CIs). Study-specific estimates were combined using the inverse variance-weighted average of logarithmic RRs in the random-effects model. One-group meta-analyses of 30-day/late (including 30-day) mortality rates were also performed in the random-effects model. RESULTS: Of 270 potentially relevant articles screened initially, 17 eligible studies including a total of 1017 patients undergoing VIV/VIR-TMVI were identified. In all but four studies, the STS-PROM was available and varied from 7.7% to 22.0% (weighted mean, 11.5%). Pooled analyses of all VIV/VIR-TMVI studies demonstrated the 30-day mortality rate of 5.4% (95%CI, 4.0-6.8%), the midterm (1- to 5-year) mortality rate of 13.7% (95%CI, 9.0-18.5%), and significantly lower observed 30-day mortality than predicted operative mortality (RR, 0.67; 95%CI, 0.49-0.91; P = 0.01). CONCLUSIONS: VIV/VIR-TMVI brought about relatively low early and midterm (1- to 5-year) mortality, and observed 30-day mortality was significantly lower than predicted operative mortality.
OBJECTIVES: We performed a meta-analysis of transcatheter mitral valve implantation (TMVI) for deteriorated bioprosthetic valves (valve-in-valve [VIV]-TMVI) and/or failed annuloplasty rings (valve-in-ring [VIR]-TMVI), comparing observed early (30-day) mortality with predicted operative mortality. BACKGROUND: It remains unclear whether VIV/VIR-TMVI reduces mortality as compared with redo MVS. METHODS: MEDLINE and EMBASE were searched current through 24 July 2018 using Web-based search engines (PubMed and OVID) to identify studies including ≥10 patients undergoing VIV/VIR-TMVI. For each study, data regarding observed 30-day mortality and predicted operative mortality (Society of Thoracic Surgeons Predicted Risk of Mortality [STS-PROM]) were used to generate risk ratios (RRs) and 95% confidence intervals (CIs). Study-specific estimates were combined using the inverse variance-weighted average of logarithmic RRs in the random-effects model. One-group meta-analyses of 30-day/late (including 30-day) mortality rates were also performed in the random-effects model. RESULTS: Of 270 potentially relevant articles screened initially, 17 eligible studies including a total of 1017 patients undergoing VIV/VIR-TMVI were identified. In all but four studies, the STS-PROM was available and varied from 7.7% to 22.0% (weighted mean, 11.5%). Pooled analyses of all VIV/VIR-TMVI studies demonstrated the 30-day mortality rate of 5.4% (95%CI, 4.0-6.8%), the midterm (1- to 5-year) mortality rate of 13.7% (95%CI, 9.0-18.5%), and significantly lower observed 30-day mortality than predicted operative mortality (RR, 0.67; 95%CI, 0.49-0.91; P = 0.01). CONCLUSIONS: VIV/VIR-TMVI brought about relatively low early and midterm (1- to 5-year) mortality, and observed 30-day mortality was significantly lower than predicted operative mortality.
Authors: Isaac Wamala; Axel Unbehaun; Christoph Klein; Marian Kukucka; Dirk Eggert-Doktor; Semih Buz; Julia Stein; Simon Sündermann; Volkmar Falk; Jörg Kempfert Journal: Interact Cardiovasc Thorac Surg Date: 2021-05-10