title: Transapical transcatheter mitral valve-in-valve implantation versus minimally invasive surgery for failed mitral bioprostheses.
abstract: The aim of this study was to compare early outcomes and survival of patients undergoing minimally invasive mitral valve replacement through a right anterior minithoracotomy (MIMVR) versus patients undergoing transcatheter transapical mitral valve-in-valve (M-VIV) implantation for a failed mitral bioprostheses.
  
  
  
  From 2005 to 2015, 61 patients with a failed mitral bioprosthesis underwent either MIMVR ( n  = 40 patients, 65.6%) or M-VIV implantation ( n  = 21, 34.4%) at our institution. The groups were compared in terms of early outcomes and survival rates. Treatment selection bias was controlled by a propensity score and was included along with the comparison variable in the multivariable analyses of outcome.
  
  
  
  Patients with M-VIV implantation were older ( P  = 0.03), had more pulmonary hypertension ( P  = 0.02) and a higher EuroSCORE ( P  = 0.001). In-hospital mortality was 7.5% ( n  = 3) in the MIMVR group and 4.7% ( n  = 1) in the M-VIV group [odds ratio (OR) = 2.46; P  = 0.512]. Incidence of stroke was 12.5% ( n  = 5) in the MIMVR group vs 4.7% ( n  = 1) in the M-VIV group (OR = 0.887; P  = 0.935). No significant differences were noted in postprocedural complications, even after adjusting the results for the propensity score. M-VIV patients had shorter stays in the intensive care unit and in the hospital ( P  = 0.02). In the M-VIV group, 28% ( n  = 7) had less than mild paravalvular leakage, whereas no patients had mild paravalvular leakage in the MIMVR group ( P  < 0.001). Finally, the 2-year survival rates were 86 ± 1% vs 87 ± 1% in patients undergoing MIMVR compared with those undergoing M-VIV implantation, respectively ( P  = 0.1).
  
  
  
  In selected patients, M-VIV can be performed safely with results comparable with those of surgical therapy.
authors.affiliation: Operative Units of Cardiac Surgery, Interventional Cardiology and Cardiology, Ospedale G. Pasquinucci, Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Murzi
authors.affiliation: Operative Units of Cardiac Surgery, Interventional Cardiology and Cardiology, Ospedale G. Pasquinucci, Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Berti
authors.affiliation: Operative Units of Cardiac Surgery, Interventional Cardiology and Cardiology, Ospedale G. Pasquinucci, Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Gasbarri
authors.affiliation: Operative Units of Cardiac Surgery, Interventional Cardiology and Cardiology, Ospedale G. Pasquinucci, Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Trianni
authors.affiliation: Operative Units of Cardiac Surgery, Interventional Cardiology and Cardiology, Ospedale G. Pasquinucci, Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Maffei
authors.affiliation: Operative Units of Cardiac Surgery, Interventional Cardiology and Cardiology, Ospedale G. Pasquinucci, Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Solinas
authors.affiliation: Division of Cardiology, University of Washington, Seattle, Washington.
authors.forename: Danny
authors.initials: D
authors.lastname: Dvir
authors.affiliation: Operative Units of Cardiac Surgery, Interventional Cardiology and Cardiology, Ospedale G. Pasquinucci, Fondazione Toscana G. Monasterio, Massa, Italy.
authors.forename: Alfredo Giuseppe
authors.initials: AG
authors.lastname: Cerillo
mesh_terms: D000368:Aged; D001705:Bioprosthesis / Q000009:adverse effects*; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D008943:Mitral Valve / Q000601:surgery*; D057216:Propensity Score; D011475:Prosthesis Failure; D012086:Reoperation; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Minimally invasive valve surgery; Mitral valve; Transcatheter valve therapy