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Transcatheter Aortic Valve Implantation for Degenerated Mitral or Tricuspid Bioprostheses: A Review of Clinical Effectiveness and Cost-Effectiveness

Last updated: June 29, 2020
Project Number: RC1283-000
Product Line: Rapid Response
Research Type: Device
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of transcatheter aortic valve implantation for degenerated mitral or tricuspid bioprostheses?
  2. What is the cost-effectiveness of transcatheter aortic valve implantation for degenerated mitral or tricuspid bioprostheses?

Key Message

Three low-quality studies were retrieved surrounding the clinical effectiveness of aortic valves for degenerated mitral or tricuspid valve bioprostheses. Two retrospective cohort studies in patients with degenerated mitral valve bioprostheses reported no difference for in-hospital mortality, or mortality at one and two years, for transcatheter mitral valve-in-valve procedures compared to surgical replacement. One study also concluded that there was a trend towards improved clinical outcomes, such as reduced rates of stroke and bleeding, for transcatheter procedures compared to surgical replacement; however, these differences were not statistically significant. There were serious limitations in both studies related to selection bias, bias due to confounding, and small sample size (121 patients in one study and 61 patients in the other study). One before-after study in patients with degenerated tricuspid valve bioprostheses reported that the proportion of patients in New York Heart Association Class I or II at 30 days and last follow-up after transcatheter valve-in-valve procedures increased compared to baseline (i.e., representing improved functional status). However, there was no comparison group in this study.No relevant economic evaluations were identified and thus the cost-effectiveness of transcatheter aortic valve implantation for degenerated mitral or tricuspid valves is unclear. Further research is necessary to establish the clinical effectiveness and cost-effectiveness of transcatheter aortic valve implantation for degenerated mitral or tricuspid bioprostheses compared to open-heart surgical procedures. To generate higher-quality evidence, such studies should feature larger sample sizes and appropriate techniques to mitigate selection bias and bias due to confounding.