Outcomes for Percutaneous Mitral Valve-in-Valves and Mitral Valve-in-Rings in the Transapical and Transseptal Access Routes: A Systematic Review and Pooled Analysis. Issue 3 (4th May 2018)

• Record Type: Journal Article
• Authors: Sengodan, Prasanna; Sankaramangalam, Kesavan; Banerjee, Kinjal; Athappan, Ganesh; Jobanputra, Yash; Krishnaswamy, Amar; Tuzcu, Murat E.; Kapadia, Samir
• Is Part Of: Structural heart. Volume 2:Issue 3(2018)
• Page Start: 214
• Page End: 220
• Publication Date: 2018-05-04
• Subjects: Mitral valve-in-valve -- mitral valve-in-ring -- percutaneous repair -- transapical -- transseptal; Heart -- Diseases -- Periodicals; Congenital heart disease -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular Diseases; Cardiovascular system -- Diseases; Congenital heart disease; Heart -- Diseases; Periodicals; 616.12
• DOI: 10.1080/24748706.2018.1445883
• Languages: English
• ISSNs: 2474-8706

Abstract

ABSTRACT: Background: The transapical (TA) route for mitral valve-in-valve (MVIV) and mitral valve-in-ring (MVIR) techniques has been predominantly used. Currently, there is an increasing trend towards the transseptal (TS) route. The purpose of the study was to assess the outcomes of TA and TS access for percutaneous MVIV and MVIR techniques in terms of procedural success, 30-day mortality, major bleeding events and valve embolization. Methods: A comprehensive literature search of EMBASE, PubMed, and the Cochrane CENTRAL was completed. We identified and pooled all studies reporting either the TS or TA approach for MVIV or MVIR with at least five patients using weighted proportional analysis. For analysis we used studies reporting the outcomes of percutaneous MVIV or MVIR based on the TS/TA approach. Results: From the initial 1, 993 abstracts, 15 studies reporting on 236 patients were analyzed to find the pooled estimate of the endpoints. In the TA arm, 11 studies were included, and in the TS arm, 8 studies were included. Of these, 5 studies reported data for both the TA and TS arms. There was no difference between the groups in terms of technical success, 30-day all-cause mortality, major bleeding events, and valve embolization. Conclusion: Although the TA approach has been used in most of the published studies, the TS approach appears to be equally effective at 30 days. Long-term studies are needed to establish the relative efficacy of one approach over the other.