Comparison of Outcomes After Transcatheter Versus Surgical Repeat Mitral Valve Replacement

ABSTRACT Introduction: Repeat transcatheter mitral valve replacement (rTMVR) has emerged as a new option for the management of high-risk patients unsuitable for repeat surgical mitral valve replacement (rSMVR). The aim of this study was to compare hospital outcomes, survival, and reoperations after rTMVR versus surgical mitral valve replacement. Methods: We compared patients who underwent rTMVR (n=22) from 2017 to 2019 (Group 1) to patients who underwent rSMVR (n=98) with or without tricuspid valve surgery from 2009 to 2019 (Group 2). We excluded patients who underwent a concomitant transcatheter aortic valve replacement or other concomitant surgery. Results: Patients in Group 1 were significantly older (72.5 [67-78] vs. 57 [52-64] years, P<0.001). There was no diference in EuroSCORE II between groups (6.56 [5.47-8.04] vs. 6.74 [4.28-11.84], P=0.86). Implanted valve size was 26 (26-29) mm in Group 1 and 25 (25-27) mm in Group 2 (P=0.106). There was no diference in operative mortality between groups (P=0.46). However, intensive care unit (ICU) and hospital stays were shorter in Group 1 (P=0.03 and <0.001, respectively). NYHA class improved significantly in both groups at one year (P<0.001 for both groups). There was no group effect on survival (P=0.84) or cardiac readmission (P=0.26). However, reoperations were more frequent in Group 1 (P=0.01). Conclusion: Transcatheter mitral valve-in-valve could shorten ICU and hospital stay compared to rSMVR with a comparable mortality rate. rTMVR is a safe procedure; however, it has a higher risk of reoperation. rTMVR can be an option in selected high-risk patients.

摘要
引言：再次经导管二尖瓣置换术（repeat transcatheter mitral valve replacement, rTMVR）已成为不适合接受外科再次二尖瓣置换术（repeat surgical mitral valve replacement, rSMVR）的高危患者的新兴治疗选择。本研究旨在对比rTMVR与外科再次二尖瓣置换术后的住院结局、生存情况及再次手术发生情况。
方法：本研究纳入2017至2019年接受rTMVR的患者（n=22，组1），以及2009至2019年接受rSMVR（联合或不联合三尖瓣手术）的患者（n=98，组2）。本研究排除了同期接受经导管主动脉瓣置换术或其他同期手术的患者。
结果：组1患者年龄显著更高（72.5 [67~78] vs. 57 [52~64] 岁，P<0.001）。两组患者的欧洲心脏手术风险评估系统Ⅱ（EuroSCORE II）评分无显著差异（6.56 [5.47~8.04] vs. 6.74 [4.28~11.84]，P=0.86）。组1植入瓣膜尺寸为26 [26~29] mm，组2为25 [25~27] mm（P=0.106）。两组患者的手术死亡率无显著差异（P=0.46）。但组1患者的重症监护病房（intensive care unit, ICU）停留时长与住院时长均更短（分别为P=0.03与P<0.001）。两组患者术后1年的纽约心脏协会（New York Heart Association, NYHA）心功能分级均显著改善（两组均P<0.001）。两组患者的生存率（P=0.84）与心脏再入院率（P=0.26）均无组间差异。但组1患者的再次手术率更高（P=0.01）。
结论：与rSMVR相比，经导管瓣中瓣二尖瓣置换术可缩短重症监护病房停留时长与住院时长，且死亡率相当。rTMVR是一项安全的手术方式，但再次手术风险更高。rTMVR可作为经筛选的高危患者的治疗选择。