April 21, 2026 — A new multicenter study published in The Annals of Thoracic Surgery finds that reoperative surgical mitral valve replacement (rSMVR) is associated with significantly better long-term survival compared to transcatheter mitral valve-in-valve (mViV) procedures in patients with failing bioprosthetic mitral valves. While both approaches demonstrated similar safety and procedural success at 30 days, key differences emerged over time, particularly beyond the first year.
Researchers analyzed outcomes from 229 patients treated at two high-volume centers between 2004 and 2023. Short-term results were largely comparable, although mViV patients experienced shorter hospital stays and fewer early complications such as atrial fibrillation and prolonged ventilation. However, at five years, patients undergoing rSMVR had significantly lower mortality (20.3% vs. 40.9%) and more favorable valve performance, with consistently lower mitral valve gradients.
“Although transcatheter valve-in-valve procedures offer clear short-term advantages, our findings suggest that surgery provides greater durability and improved long-term survival in appropriately selected patients,” said S. Christopher Malaisrie, MD, lead author and professor of surgery at Northwestern Medicine. “Survival outcomes between the two groups began to diverge after one year and continued to widen over time.”
Importantly, rates of reintervention and heart failure were similar between groups, indicating that both strategies remain viable depending on patient risk and clinical context. The study highlights the importance of multidisciplinary heart team decision-making, balancing the lower early risk of mViV against the long-term benefits of surgical reintervention.
“These findings support current guideline recommendations that favor surgical replacement in low-risk patients with longer life expectancy, while reserving transcatheter approaches for those at higher operative risk,” said Dr. Malaisrie. Future research is needed to better define patient selection criteria and evaluate long-term valve durability across treatment strategies.
The full study, “Long-Term Survival Advantage of Reoperative Surgical Mitral Valve Replacement Over Transcatheter Mitral Valve-in-Valve: A Multicenter Cohort,” is now available online in The Annals of Thoracic Surgery.
November 03, 2026 
