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Nappi et al. Vessel Plus 2021;5:40 https://dx.doi.org/10.20517/2574-1209.2021.06 Page 5 of 20

Table 1. Baseline characteristics of all patients in transcatheter approach group [1,15,23,24,26,31]

Age, y, STS NYHA Class LVEF (%; mean ±
Overall TMViV TMViR TMVIMAC
median score III or IV SD)

US Registry 349 266 83 76 11.1
Brigham and Women’s Hospital 520 prev prev 63.3 ± 13.5 6.12 ± 319 60
MVR MVP 6.52

273 247
TMVR Registry 248 176 72 72.5 ± 12.1 8.9 ± 6.8 221 52.5 ± 13.9
Mayo Clinic, NY University Medical Centre, Intermounitain Heart Institute, University of 87 60 15 12 75 ± 11 13 ± 8 87 57 ± 11
Alabama, St. Michael’s Hospital, Centre Cardiologique du Nord
Multicentre Published reports (2009-2018) 245 172 73 73 ± 12.1 15.6 ± 98.2 46.7 ± 14.1
13.5
Flinders Medical Centre (Adelaide) (2017-2018) 7 7 82 4.34 5 > 60% (5); 30%-
45% (2)
St. Paul’s Hospital (Vancouver, Canada) 23 23 81.1 ± 5.8 12.6 ± 22 54.5 ± 12.3
6.9

TMViV: Transcatheter mitral valve-in-valve; TMViR: transcatheter mitral valve-in-ring; STS: Society of Thoracic Surgeons; NYHA: New York Heart Association; LVEF: left ventricle ejection fraction; TMVR:
transcatheter mitral valve replacement; TMVIMAC: transchateter mitral valve in mitral annular calcification; MVR: mitral valve repair; MVP: mitral valve replacement.

TMViV (6.9% vs. 2.3%; P = 0.07), respectively. The concern related to life-threatening or fatal bleeding more frequently affected TMViR recipients (8.3%

TMViR vs. 2.3% TMViV; P = 0.03), while reoperation was necessary for 25 patients (10.1%), more frequently in the TMViR arm than in the TMViV one
(16.7% vs. 7.4%; P = 0.03) [18,26] .

The survival benefits of TMViV-T in a small number of patients with failed bioprosthetic mitral valves were proved in a report by Nappi et al. and
[32]
Webb et al. nearly 10 years ago. TMViV-T was used for 24 high-risk patients with degenerated valves bioprostheses (aortic, n = 10; mitral, n = 7; pulmonary,
[33]
n = 6; or tricuspid, n = 1). The first-in-human use of a percutaneous transseptal approach was unsuccessful. On the contrary, five subsequent patients were
managed successfully with the use of transapical access for TMViV implantations. The procedure was relatively easily accomplished; all patients not only

survived at 30-day follow-up, but there was no mortality at a median 72-day follow-up [16,18,19,28] .

TMViR has been used since 2010 in a restricted number of patients (n = 17) who had failed annuloplasty rings, demonstrating how promising this safe and

efficacious approach is for this type of mechanical intervention. The survival rate survival was 82% (14/17 patients) at 30 days, while, at the most recent follow-
up (13 ± 5 months), the percentage of surviving patients dropped to 71% (12/17) .
[34]