Objective To compare the effectiveness and safety for transcatheter mitral valve replacement(TMVR)versus redo surgical mitral valve replacement(redo SMVR)in patients with failed mitral bioprostheses or failed annuloplasty rings.Methods PubMed,The Cochrane Library,Web of Science,Embase,China National Knowledge Infrastructure(CNKI),China Science and Technology Journal Database(VIP),Wanfang Data and China Biology Medicine(CBM)were searched from inception until August 2023.Two reviewers independently screened the literatures,extracted the data and evaluated the quality of the included studies by the criteria of inclusion and exclusion.Then,RevMan 5.3 and Stata 16.0 software was used for meta-analysis.Results A total of thirteen cohort studies were included with 14 226 patients,including 3 379 patients of TMVR and 10 847 patients of redo SMVR.Meta-analysis results showed,compared with the redo SMVR patients,the TMVR patients had lower in-hospital mortality(OR=0.76,95％ CI:0.63 to 0.90,P=0.002),lower incidence of in-hospital stroke(OR=0.48,95％ CI:0.36 to 0.63,P＜0.001),lower incidence of bleeding events(OR=0.24,95％ CI:0.18 to 0.32,P＜0.001),lower incidence of acute kidney injury(OR=0.52,95％ CI:0.45 to 0.60,P＜0.001),lower incidence of permanent pacemaker implantation(OR=0.25,95％ CI:0.18 to 0.35,P＜0.001),lower incidence of in-hospital cardiogenic shock(OR=0.49,95％ CI:0.34 to 0.72,P＜0.001),lower intra-aortic balloon pump(OR=0.41,95％CI:0.19 to 0.91,P=0.030),lower incidence of new-onset atrial fibrillation(OR=0.22,95％ CI:0.07 to 0.74,P=0.010),less operation time(WMD=-225.88,95％ CI:-283.56 to-168.19,P＜0.001),shorter length of stay in the ICU(WMD=-2.02,95％ CI:-2.32 to-1.72,P＜0.001)and shorter length of stay in the hospital(WMD=-5.97,95％ CI:-7.87 to-4.06,P＜0.001).But the mitral valve mean gradient(WMD=1.30,95％ CI:0.76 to 1.84,P＜0.001)at 1 year postoperative of patients undergone TMVR was higher than redo SMVR group.There was no difference in 1-year mortality(OR=1.06,95％ CI:0.70 to 1.61,P=0.770)and 2-years mortality(OR=1.90,95％ CI:0.98 to 3.66,P=0.060)between TMVR and redo SMVR patients.Conclusions Compared with redo SMVR for patients with failed mitral bioprostheses or failed annuloplasty rings,TMVR is associated with higher safety,fewer complications,and faster short-term postoperative recovery.However,there is no significant difference in 1-year and 2-year postoperative mortality.
维普
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