Submitted: 07 Jul 2018
Revised: 22 Oct 2018
Accepted: 15 Nov 2018
First published online: 09 Dec 2018
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J Cardiovasc Thorac Res. 2018;10(4):182-186.
doi: 10.15171/jcvtr.2018.31
  Abstract View: 253
  PDF Download: 149

Original Article

Outcomes following transcatheter transseptal versus transapical mitral valve-in-valve and valve-in-ring procedures

Salik Nazir 1 * ORCiD, Saroj Lohani 1, Niranjan Tachamo 1, Muhammad Sohail Khan 1, Bidhya Timilsina 1, Faraz Khan Luni 2, Anthony Donato 3

1 Department of Medicine, Reading Hospital-Tower Health System, West Reading, Pennsylvania, USA
2 Division of Cardiology, Mercy Saint Vincent Medical Center, Toledo, Ohio, USA
3 Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA

Abstract

Introduction: Transcatheter mitral valve-in-valve (ViV) & valve-in-ring (ViR) are relatively novel therapeutic alternatives for patients with degenerated bioprostheses or failed annuloplasty rings whose reoperative risk is too high. The predominant procedural access for both procedures is transapical or transseptal. However, whether there are differences in outcomes of this procedure using transseptal versus transapical access has not yet been defined.
Methods: We conducted a systematic review of all published articles from MEDLINE and EMBASE to explore the outcomes of these two procedural approaches.
Results: A total of 55 studies including 183 patients (154 ViV and 29 ViR) were included. Patients that underwent ViV (101 transapical and 53 transseptal) using the transseptal approach required more iatrogenic atrial septal defect (ASD) closure (19% versus 0.0 %; P < 0.001) and hence had a lower device success rate (68% versus 89%; P = 0.001). However, there was no significant difference between the two groups in procedural success and all-cause mortality at 30 days. Overall severe bleeding complications (major or life threatening) were not different the two groups (3.7% versus 7.9%; P = 0.321). In the ViR group (19 transapical and 10 transseptal), no difference in procedural success, device success or 30-day outcomes were identified between transseptal and transapical groups, although sample size was small.
Conclusion: In conclusion, mitral ViV and ViR using the two different procedural approaches appear to confer equal and reasonable 30-day outcomes.
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