Mitral Reoperation After Transcatheter Mitral Valve Replacement: The Society of Thoracic Surgeons Adult Cardiac...

Despite the global interest in transcatheter mitral valve replacement (TMVR), mitral reoperation after TMVR has not been described. We aimed to delineate the features of post-TMVR reoperations.

We queried The Society of Thoracic Surgeons (STS) Database for post-TMVR reoperations from 2013 to 2022, identifying 318 patients for analysis. Patients were grouped into valve-in-valve-TMVR (n = 186 [58.5%]), valve-in-ring-TMVR (n = 71 [22.3%]), and native-TMVR (n = 61 [19.2%]).

These reoperations were performed by 283 surgeons (median 1 case/surgeon) from 162 centers (median 1 case/center). The case volume increased from 1 in 2013 to 75 in 2022. Conversely, same-day open conversions during TMVR declined to only 1.3% (1 of 75 cases) in 2022. Overall, the median age was 67 years, and 56.9% were urgent/emergent. Native TMVR reoperations were generally higher risk, with patients being significantly older and most commonly emergent status. Operative mortality was 18.3%, 15.5%, and 27.9% in the valve-in-valve-TMVR, valve-in-ring-TMVR, and native-TMVR groups, respectively (P = .16). For the subgroup with an available STS score, the predicted risk of mortality or observed-to-expected mortality ratio did not differ by group. Elective procedures, compared with urgent/emergent procedures, demonstrated lower mortality in the valve-in-valve-TMVR (9.5% vs 26.0%; P = .002) and valve-in-ring-TMVR groups (8.3% vs 22.9%; P = .091), but not in the native-TMVR group (31.6% vs 26.2%, P = .66).

Post-TMVR reoperations remain rare but are increasing, characterized by high acuity with corresponding high mortality, particularly native-TMVRs. In the absence of clear reintervention data after TMVR, transparent counseling of the undefined post-TMVR pathway and judicious TMVR candidate selections are necessary as TMVR practices expand globally.