Transcatheter mitral valve implantation versus conventional redo surgery for degenerated mitral valve prostheses and rings in a multicenter registry

Michal Szlapka, Harald Hausmann, Jürgen Timm, Adrian Bauer, Dietrich Metz, Daniel Pohling, Dirk Fritzsche, Takayuki Gyoten, Thomas Kuntze, Hilmar Dörge, Richard Feyrer, Agrita Brambate, Ralf Sodian, Stefan Buchholz, Falk Udo Sack, Martina Höhn, Theodor Fischlein (Co-author), Walter Eichinger, Ulrich Franke, Ragi NagibArbeitsgemeinschaft Leitender herzchirurgischer Krankenhausärzte e.V. (ALHK) Study Group

Research output: Contribution to journalOriginal Article (Journal)peer-review

7 Citations (Web of Science)


OBJECTIVES: Degeneration of mitral prostheses/rings may be treated by redo surgery, and, recently, by transcatheter valve-in-valve/ring implantation. This multicenter registry presents results of transcatheter valve-in-valve and repeat surgery for prostheses/rings degeneration.

METHODS: Data provided by 10 German heart centers underwent propensity score-matched retrospective analysis. The primary endpoint was 30-day/midterm mortality. Perioperative outcome was assessed according to the Mitral Valve Academic Research Consortium criteria. Further, the influence of moderate or greater tricuspid regurgitation (TR) on 30-day/midterm mortality was analyzed.

RESULTS: Between 2014 and 2019, 273 patients (79 transcatheter mitral valve-in-valve [TM-ViV] and 194 redo mitral valve replacement [Re-MVR]) underwent repeat procedure for mitral prosthesis/ring degeneration. Propensity score matching distinguished 79 patient pairs. European System for Cardiac Operative Risk Evaluation (EuroSCORE) II-predicted risk was 15.7 ± 13.7% in the TM-ViV group and 15.0% ± 12.7% in the Re-MVR group (P = .5336). TM-ViV patients were older (74.73 vs 72.2 years; P = .0030) and had higher incidence of atrial fibrillation (54 vs 40 patients; P = .0233). Severe TR incidence was similar (17.95% in TM-ViV vs 14.10%; P = .1741). Sixty-eight TM-ViV patients previously underwent mitral valve replacement, whereas 41 Re-MVR patients underwent valve repair (P < .0001). Stenosis was the leading degeneration mechanism in 42 TM-ViV versus 22 Re-MVR patients (P < .0005). The 30-day/midterm mortality did not differ between groups. Moderate or greater TR was a predictor of total (odds ratio [OR], 4.36; P = .0011), 30-day (OR, 3.76; P = .0180), and midterm mortality (OR, 4.30; P = .0378), irrespective of group.

CONCLUSIONS: In both groups, observed mortality was less than predicted. Redo surgery enabled treatment of concomitant conditions, such as atrial fibrillation or TR. TR was shown to be a predictor of total, 30-day, and midterm mortality in both groups.

Original languageEnglish
Pages (from-to)957-964
Number of pages8
JournalThe Journal of thoracic and cardiovascular surgery
Issue number3
Publication statusPublished - Mar 2024


  • Humans
  • Mitral Valve/diagnostic imaging
  • Heart Valve Prosthesis Implantation/methods
  • Retrospective Studies
  • Atrial Fibrillation/surgery
  • Prosthesis Failure
  • Treatment Outcome
  • Heart Valve Prosthesis
  • Transcatheter Aortic Valve Replacement/methods
  • Reoperation
  • Tricuspid Valve Insufficiency/surgery
  • Registries
  • Bioprosthesis
  • Risk Factors


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