Mitral Reoperation After Transcatheter Mitral Valve Replacement: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis

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BACKGROUND: 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. METHODS: 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%]). RESULTS: 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). CONCLUSIONS: 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.

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