Eleid Mackram F, Krishnaswamy Amar, Kapadia Samir, Yadav Pradeep, Rajagopal Vivek, Makkar Raj, Stinis Curtiss, Chetcuti Stanley, Morse Andrew, Frisoli Tiberio, Frangieh Antonio H, Abbas Amr E, Whisenant Brian, O'Neill William W, Guerrero Mayra E, Rodriguez Evelio, Kodali Susheel, Ailawadi Gorav, Rihal Charanjit S
Mayo Clinic, Rochester, Minnesota, USA.
Cleveland Clinic, Cleveland, Ohio, USA.
JACC Cardiovasc Interv. 2025 Jun 9;18(11):1454-1466. doi: 10.1016/j.jcin.2025.03.017.
Mitral valve-in-valve (MViV) is a safe and effective therapy for severe bioprosthetic mitral degeneration; however, longer-term outcomes are not well defined.
This study aimed to evaluate 3-year outcomes following MViV.
Outcomes of all-cause mortality, stroke, and reintervention were collected in patients undergoing transseptal MViV with the SAPIEN 3 valve family for failed surgical bioprostheses from June 2015 to March 2024 in the TVT (Transcatheter Valve Therapy) Registry, and Centers for Medicare and Medicaid Services data linkage was performed. Kaplan-Meier and Cox proportional hazards analysis was performed according to Society of Thoracic Surgeons (STS) score and procedure status.
A total of 5,971 patients (age 72.9 ± 11.4 years, 57.9% [n = 3457 of 5,971] female) underwent MViV. Low (<4), intermediate (4-8), and high (>8) STS scores were present in 23.5% (n = 1,310 of 5,585), 35.1% (n = 1,960 of 5,585) and 41.5% (n = 2,315 of 5,585) of patients, respectively. Median follow-up duration was 377 days (Q1-Q3: 57-698 days). Mortality at 3 years was greatest in high STS score and nonelective procedures, while mortality was lowest in low STS score patients and elective procedures. Stroke rates at 3 years were comparable except between low and high STS groups. Mitral valve reintervention during 3 years of follow-up was uncommon in all groups.
Three-year survival after MViV is highest in low STS scores and elective procedures, whereas survival was significantly lower in high STS scores and nonelective procedures. These findings emphasize the importance of early identification and treatment of patients who may benefit from MViV. Reintervention rates at 3 years are low regardless of STS score.
二尖瓣瓣中瓣（MViV）是治疗严重生物瓣二尖瓣退化的一种安全有效的方法；然而，其长期预后尚不清楚。
本研究旨在评估MViV术后3年的预后。
收集2015年6月至2024年3月在经导管瓣膜治疗（TVT）注册中心接受经房间隔MViV置入SAPIEN 3瓣膜系列治疗失败的外科生物瓣患者的全因死亡率、卒中及再次干预的预后情况，并进行医疗保险和医疗补助服务中心的数据关联分析。根据胸外科医师协会（STS）评分和手术状态进行Kaplan-Meier分析和Cox比例风险分析。
共有5971例患者（年龄72.9±11.4岁，57.9%[5971例中的3457例]为女性）接受了MViV治疗。STS低（<4）、中（4-8）、高（>8）分的患者分别占23.5%（5585例中的1310例）、35.1%（5585例中的1960例）和41.5%（5585例中的2315例）。中位随访时间为377天（第一四分位数-第三四分位数：57-698天）。3年死亡率在STS高分和非选择性手术患者中最高，而在STS低分患者和选择性手术患者中最低。除STS低分组和高分组之间外，3年卒中发生率相当。在所有组中，随访3年期间二尖瓣再次干预并不常见。
MViV术后3年生存率在STS低分和选择性手术患者中最高，而在STS高分和非选择性手术患者中显著较低。这些发现强调了早期识别和治疗可能从MViV中获益的患者的重要性。无论STS评分如何，3年再次干预率都很低。
