With heightened awareness of mitral valve disease and improvement in surgical techniques, the use of mitral valve bioprostheses has increased. There is a large aging population with prior surgical valvular interventions. Limited durability of the prosthesis due to valvular degeneration over time may necessitate the need for repair or replacement of the prior prosthesis in the future. This usually entails another surgical intervention in this population with elevated risk for a reoperation. There is an ongoing clinical need for newer, less invasive options that are feasible and carry a lower complication rate. The advent of transcatheter heart valve (THV) therapies has opened up a wide range of therapeutic options for treatment of a failed bioprosthesis. Their safety and feasibility are now well established. This article serves as a review of the currently available THVs for implantation in the mitral position, the pre-procedural assessment, the challenges associated with implantation, as well as outcomes associated with a mitral valve-in-valve (VIV) and a mitral valve-in-ring (VIR) procedure.

Corticosteroid use is associated with vascular fragility, prolonged wound healing, and infections. Therefore, we sought to compare outcomes between patients with aortic stenosis undergoing transcatheter aortic valve replacement who were using corticosteroids versus those who were not. This is a study-level meta-analysis and meta-regression of observational studies. The primary end points of this study were rates of vascular complication (both major and minor), life-threatening bleeding, and 30-day mortality. Secondary end points included acute kidney injury rates, annular rupture, cardiac tamponade, closure device failure, coronary obstruction, periprocedural myocardial infarction, permanent pacemaker implantation, stroke, and specific vascular complications with its complementary therapy. Across the studies, patients were slightly predominantly female, older, and had a mean left ventricular ejection fraction of more than 50% with an intermediate Logistic EuroScore II. Significant differences were observed in the vascular complication rates between patients on corticosteroids and those who were corticosteroid-free (relative risk, 0.63; 95% CI, 0.35-0.90; P <.001), driven primarily by arterial occlusion, surgery, balloon angioplasty, and stenting (relative risk, 0.63; 95% CI, 0.32-0.93; P <.05). There was no difference in the 30-day mortality. No differences were seen in the length of corticosteroid therapies. For the secondary outcomes, there was an increased risk of annular rupture and cardiac tamponade in patients taking corticosteroids. In conclusion, this is the first meta-analysis with meta-regression that showed a higher risk for vascular complications and life-threatening bleeding in patients on corticosteroid therapy undergoing transcatheter aortic valve replacement, despite no increase in the risk of 30-day mortality.

Background. Transcatheter aortic valve replacement (TAVR) is known to increase the incidence of conduction disturbances compared to surgical aortic valve replacement; however, there are limited data on the impact and duration of these conduction disturbances on longer term outcomes. Objective. To determine the differential impact of persistent versus nonpersistent new-onset conduction disturbances on TAVR-related complications and outcomes. Methods. This is a single-center retrospective analysis of 927 consecutive patients with aortic stenosis who underwent TAVR at Yale New Haven Hospital from July 2012 to August 2019. Patients with new-onset conduction disturbances within 7 days following TAVR were selected for this study. Persistent and nonpersistent disturbances were, respectively, defined as persisting or not persisting on all patient ECGs for up to 1.5 years after TAVR or until death. Results. Within 7 days after TAVR, conduction disturbances occurred in 42.3% (392/927) of the patients. Conduction disturbances persisted in 150 (38%) patients and did not persist in 187 (48%) patients, and 55 (14%) patients were excluded for having mixed (both persistent and nonpersistent) disturbances. Compared with nonpersistent disturbances, patients with persistent disturbances were more likely to receive a PPM within 7 days after the TAVR procedure (46.0% versus 4.3%, ) and had a greater unadjusted 1-year cardiac-related and all-cause mortality risk (HR 2.54, and HR 1.90, , respectively). Conclusion. Persistent conduction disturbances were associated with a greater cardiac and all-cause mortality rate at one year following TAVR. Future research should investigate periprocedural factors to reduce persistent conduction disturbances and outcomes beyond one year follow-up.