{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:53:35Z","timestamp":1791356015382,"version":"4.3.1"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,10,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Transcatheter mitral valve replacement (TMVR) using the Sapien (Edwards Lifesciences, Irvine, CA) transcatheter heart valve has become the preferred treatment for high\u2010risk patients with failed mitral bioprosthetic valves or prior surgical mitral valve repairs. Differences in anatomy and procedural complexity between valve\u2010in\u2010valve TMVR (ViV\u2010TMVR) and valve\u2010in\u2010ring TMVR (ViR\u2010TMVR) may influence clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We systematically searched OVID Medline, Embase, SCOPUS, Web of Science, and Cochrane for studies published between 2015 and 2022 comparing ViV\u2010TMVR and ViR\u2010TMVR. The primary end point was 30\u2010day all\u2010cause mortality. Secondary outcomes included in\u2010hospital mortality, stroke, acute kidney injury, major bleeding, reintervention, left ventricular outflow tract obstruction, and device embolization. Random\u2010effects models were used to pool outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Eight studies including 1947 patients (ViV\u2010TMVR: 1435; ViR\u2010TMVR: 512) were analyzed. Patients undergoing ViV\u2010TMVR were older and had a greater baseline comorbidity burden. No significant differences were observed in 30\u2010day mortality (odds ratio [OR]: 0.70 [95% CI: 0.47\u20131.05]; I\n                      <jats:sup>2<\/jats:sup>\n                      =0%) or in\u2010hospital mortality (OR: 1.05 [95% CI: 0.34\u20133.21]; I\n                      <jats:sup>2<\/jats:sup>\n                      =3%). Similarly, stroke, major bleeding, and device embolization did not differ significantly between groups. However, ViV\u2010TMVR was associated with lower rates of left ventricular outflow tract obstruction (OR: 0.30 [95% CI: 0.18\u20130.51]), reintervention (OR: 0.19 [95% CI: 0.13\u20130.30]), and acute kidney injury (OR: 0.51 [95% CI: 0.29\u20130.90]), with no significant heterogeneity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Compared with ViR\u2010TMVR, ViV\u2010TMVR was associated with lower rates of left ventricular outflow tract obstruction, reintervention, and acute kidney injury, whereas mortality and other major complications were comparable. These findings may inform patient selection and procedural planning for transcatheter mitral valve interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.044789","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:27:25Z","timestamp":1789738045000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Pooled Analysis of Valve\u2010in\u2010Valve and Valve\u2010in\u2010Ring Transcatheter Mitral Valve Replacement Using the SAPIEN Valve"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2680-7047","authenticated-orcid":false,"given":"Chloe","family":"Kharsa","sequence":"first","affiliation":[{"name":"Houston Methodist DeBakey Heart and Vascular Center","place":["Houston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahar","family":"Samimi","sequence":"additional","affiliation":[{"name":"Michael E DeBakey VA Medical Center","place":["Houston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7885-6667","authenticated-orcid":false,"given":"Ankit","family":"Agrawal","sequence":"additional","affiliation":[{"name":"Cleveland Clinic","place":["Cleveland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1559-6911","authenticated-orcid":false,"given":"Safi U.","family":"Khan","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart and Vascular Center","place":["Houston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad N.","family":"Lone","sequence":"additional","affiliation":[{"name":"Division of Cardiology Guthrie Robert Packer Hospital Sayre PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihao","family":"Zhu","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart and Vascular Center","place":["Houston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7029-2780","authenticated-orcid":false,"given":"Mary","family":"Schleicher","sequence":"additional","affiliation":[{"name":"Cleveland Clinic","place":["Cleveland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4501-1005","authenticated-orcid":false,"given":"Usman Ali","family":"Akbar","sequence":"additional","affiliation":[{"name":"West Virginia University\u2013Camden Clark Medical Center","place":["Parkersburg"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2690-1646","authenticated-orcid":false,"given":"Hassaan Bin","family":"Arshad","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart and Vascular Center","place":["Houston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6619-5806","authenticated-orcid":false,"given":"Marvin D.","family":"Atkins","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart and Vascular Center","place":["Houston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2880-6132","authenticated-orcid":false,"given":"Michael J.","family":"Reardon","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart and Vascular Center","place":["Houston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadeen N.","family":"Faza","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart and Vascular Center","place":["Houston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5969-5543","authenticated-orcid":false,"given":"Stephen H.","family":"Little","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart and Vascular Center","place":["Houston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4334-8133","authenticated-orcid":false,"given":"Neal S.","family":"Kleiman","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart and Vascular Center","place":["Houston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6041-3876","authenticated-orcid":false,"given":"Sachin S.","family":"Goel","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart and Vascular Center","place":["Houston"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6339-1630","authenticated-orcid":false,"given":"Joe","family":"Aoun","sequence":"additional","affiliation":[{"name":"Houston Methodist DeBakey Heart and Vascular Center","place":["Houston"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12216712"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13019-020-01344-3"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.000699"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2008.08.058"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2007.11.039"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2013.08.028"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2014.02.050"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivs005"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/jocs.15787"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2018.08.083"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2017-312047"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2022.11.043"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.30059"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2020.2974"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2021.08.044"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2010.02.007"},{"key":"e_1_3_1_18_2","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins JPT","year":"2024","unstructured":"Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, eds. Cochrane Handbook for Systematic Reviews of Interventions. Version 6.5. Cochrane; 2024. Accessed September 2, 2026. https:\/\/www.training.cochrane.org\/handbook"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.17925\/HI.2023.17.1.19"},{"key":"e_1_3_1_20_2","unstructured":"Clinical Trial Design Principles and Endpoint Definitions for Transcatheter Mitral Valve Repair and Replacement: Part 2: Endpoint Definitions: A Consensus Document From the Mitral Valve Academic Research Consortium \u2013 ScienceDirect. [Internet]. [cited 2025 Feb 6]. https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0735109715025589#cebib0010."},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2017.08.014"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy271"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy590"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.049088"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.29779"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.29783"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.3390\/jpm13050803"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2023.06.041"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.048147"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.09.015"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.shj.2024.100299"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.xjtc.2023.03.022"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.21037\/acs-2019-mv-169"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.119.008425"},{"key":"e_1_3_1_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2020.09.027"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2018.12.001"},{"key":"e_1_3_1_37_2","volume-title":"StatPearls [Internet]","author":"Modi K","year":"2025","unstructured":"Modi K, Padala SA, Gupta M. Contrast\u2010induced nephropathy. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. [cited 2025 Feb 7]. http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK448066\/"},{"key":"e_1_3_1_38_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjcr\/ytaa101"},{"key":"e_1_3_1_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.09.582"},{"key":"e_1_3_1_40_2","doi-asserted-by":"publisher","DOI":"10.4065\/84.2.170"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.125.044789","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:26:29Z","timestamp":1791354389000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.125.044789"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":39,"journal-issue":{"issue":"19","published-print":{"date-parts":[[2026,10,6]]}},"alternative-id":["10.1161\/JAHA.125.044789"],"URL":"https:\/\/doi.org\/10.1161\/jaha.125.044789","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,6]]},"assertion":[{"value":"2025-08-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e044789"}}