Valvular & structural heart diseaseCohort study
Cardiac Reoperation or Transcatheter Mitral Valve Replacement for Patients With Failed Mitral Prostheses
- Retrospective cohort study
- propensity-score matched
Authors' conclusion
In this large cohort of Medicare beneficiaries with failed mitral prostheses, outcomes were similar between redo SMVR and TMVR at 3 years, with TMVR showing a lower initial risk but a higher risk of MACE after 6 months.
Study context
- Population
- Medicare beneficiaries aged ≥65 years with failed mitral prostheses, 2016–2020matched n = 1,317 per group
- Participants
- 4,293 beneficiaries
- Exposure
- Transcatheter mitral valve replacement (TMVR) vs redo SMVR for failed mitral prostheses
- Outcome
- MACE:
- All-cause death
- HF rehospitalization
- Stroke
- Reintervention
- Follow-up
- Mid-term (up to 3 years)
Main finding
Mid-term MACE · up to 3 years
Adjusted hazard ratio
0.92
95% CI 0.80–1.04
P = 0.2
TMVR vs redo SMVR
adjusted HR 0.92 (95% CI 0.80–1.04); P = 0.2
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | adjusted HR (95% CI) | P value | |
|---|---|---|---|
| MACE, landmark analysis — TMVR vs redo SMVR · first 6 months | 0.75 (0.63–0.88) | P < 0.001 | |
| MACE, landmark analysis — TMVR vs redo SMVR · beyond 6 months | 1.28 (1.04–1.58) | P = 0.02 | |
| 0.512Adjusted hazard ratio (log scale) |
Procedural volume and mid-term major adverse cardiovascular events (MACE)
- Increasing volume associated with decreased MACE risk after redo SMVR
- P = 0.001
- No association after TMVR
- P = 0.3
Original publication
Cardiac Reoperation or Transcatheter Mitral Valve Replacement for Patients With Failed Mitral Prostheses. J Am Coll Cardiol. Published 23 October 2023. doi:10.1016/j.jacc.2023.10.014
Summarised from the published abstract; every number is checked against it