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Page 12 of 20 Nappi et al. Vessel Plus 2021;5:40 https://dx.doi.org/10.20517/2574-1209.2021.06

Figure 3. Transcatheter or redo surgery. The choice between a transcatheter approach and a surgical approach cannot preclude the
evaluation of the first surgery, the cause of the failure of a previous repair or the presence of a degeneration of mitral valve prosthesis.
STS: Society of Thoracic Surgeons; NYHA: New York Heart Association; TMViR: transcatheter mitral valve-in-ring; TMViV:
transcatheter mitral valve-in-valve.

Short- and long-term survival is a crucial point for the success of the procedure. However, to date, we do
not have precise guidelines that orient the selection of patients who might better benefit from a TMViV-T.
Therefore, the choice of the mechanical intervention strategy is not supported by solid scientific evidence.

The literature on the subject has shown that in-hospital mortality rates are substantially lower (between 4%
[16]
and 5%) for patients who have undergone previous mitral valve repair . In contrast, the 30-day mortality
rate was significatively higher for patients who have been managed with conventional Re-MVS for
degenerated bioprostheses and ranged from 9.3% to 12%. Importantly, the pivotal study by Eleid et al.
[14]
showed a 30-day survival and freedom from secondary cardiac surgery for other complications of 85% in
TMViV and TMViR patients, while this rate was 91% in a subgroup of TMViV for failed bioprosthetic
mitral valve.

The baseline features probably explain the superior intrahospital mortality of the re-mitral valve surgery in
the pr-MVRpl group compared to TMViV. The higher operative mortality in patients who received a
reoperation for mitral valve replacement was probably related to a proportionately greater number of
patients with endocarditis or requiring associated coronary/valve surgery [21-22,44-45] .