• Michele Murzi, Sergio Berti, Tommaso Gasbarri, Giuseppe Trianni, Stefano Maffei, Marco Solinas, Danny Dvir, and Alfredo Giuseppe Cerillo.
• Operative Units of Cardiac Surgery, Interventional Cardiology and Cardiology, Ospedale G. Pasquinucci, Fondazione Toscana G. Monasterio, Massa, Italy.
• Interact Cardiovasc Thorac Surg. 2017 Jul 1; 25 (1): 57-61.

ObjectivesThe aim of this study was to compare early outcomes and survival of patients undergoing minimally invasive mitral valve replacement through a right anterior minithoracotomy (MIMVR) versus patients undergoing transcatheter transapical mitral valve-in-valve (M-VIV) implantation for a failed mitral bioprostheses.MethodsFrom 2005 to 2015, 61 patients with a failed mitral bioprosthesis underwent either MIMVR ( n  = 40 patients, 65.6%) or M-VIV implantation ( n  = 21, 34.4%) at our institution. The groups were compared in terms of early outcomes and survival rates. Treatment selection bias was controlled by a propensity score and was included along with the comparison variable in the multivariable analyses of outcome.ResultsPatients with M-VIV implantation were older ( P  = 0.03), had more pulmonary hypertension ( P  = 0.02) and a higher EuroSCORE ( P  = 0.001). In-hospital mortality was 7.5% ( n  = 3) in the MIMVR group and 4.7% ( n  = 1) in the M-VIV group [odds ratio (OR) = 2.46; P  = 0.512]. Incidence of stroke was 12.5% ( n  = 5) in the MIMVR group vs 4.7% ( n  = 1) in the M-VIV group (OR = 0.887; P  = 0.935). No significant differences were noted in postprocedural complications, even after adjusting the results for the propensity score. M-VIV patients had shorter stays in the intensive care unit and in the hospital ( P  = 0.02). In the M-VIV group, 28% ( n  = 7) had less than mild paravalvular leakage, whereas no patients had mild paravalvular leakage in the MIMVR group ( P  < 0.001). Finally, the 2-year survival rates were 86 ± 1% vs 87 ± 1% in patients undergoing MIMVR compared with those undergoing M-VIV implantation, respectively ( P  = 0.1).ConclusionsIn selected patients, M-VIV can be performed safely with results comparable with those of surgical therapy.© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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