{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T17:51:01Z","timestamp":1782323461700,"version":"3.54.5"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T00:00:00Z","timestamp":1716422400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Transcatheter mitral valve replacement (TMVR) has garnered interest as a viable alternative to the traditional surgical mitral valve replacement (SMVR) for high-risk patients requiring redo operations. This study aims to evaluate the association of TMVR with selected clinical and financial outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Adults undergoing isolated redo mitral valve replacement were identified in the 2016\u20132020 Nationwide Readmissions Database and categorized into TMVR or SMVR cohorts. Various regression models were developed to assess the association between TMVR and in-hospital mortality, as well as additional secondary outcomes. Transseptal and transapical catheter-based approaches were also compared in relation to study endpoints.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of an estimated 7,725 patients, 2,941 (38.1%) underwent TMVR. During the study period, the proportion of TMVR for redo operations increased from 17.8% to 46.7% (nptrend&lt;0.001). Following adjustment, TMVR was associated with similar odds of in-hospital mortality (AOR 0.82, p = 0.48), but lower odds of stroke (AOR 0.44, p = 0.001), prolonged ventilation (AOR 0.43, p&lt;0.001), acute kidney injury (AOR 0.61, p&lt;0.001), and reoperation (AOR 0.29, p = 0.02). TMVR was additionally correlated with shorter postoperative length of stay (pLOS; \u03b2 -0.98, p&lt;0.001) and reduced costs (\u03b2 -$10,100, p = 0.002). Additional analysis demonstrated that the transseptal approach had lower adjusted mortality (AOR 0.44, p = 0.02), shorter adjusted pLOS (\u03b2 -0.43, p&lt;0.001), but higher overall costs (\u03b2 $5,200, p = 0.04), compared to transapical.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In this retrospective cohort study, we noted TMVR to yield similar odds of in-hospital mortality as SMVR, but fewer complications and reduced healthcare expenditures. Moreover, transseptal approaches were associated with lower adjusted mortality, shorter pLOS, but higher cost, relative to the transapical. Our findings suggest that TMVR represent a cost-effective and safe treatment modality for patients requiring redo mitral valve procedures. Nevertheless, future studies examining long-term outcomes associated with SMVR and TMVR in redo mitral valve operations, are needed.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0301939","type":"journal-article","created":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T17:50:17Z","timestamp":1716486617000},"page":"e0301939","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Mortality and resource utilization in surgical versus transcatheter repeat mitral valve replacement: A national analysis"],"prefix":"10.1371","volume":"19","author":[{"given":"Nguyen K.","family":"Le","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0327-9847","authenticated-orcid":true,"given":"Nikhil","family":"Chervu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saad","family":"Mallick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3778-1966","authenticated-orcid":true,"given":"Amulya","family":"Vadlakonda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shineui","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Curry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4705-0262","authenticated-orcid":true,"given":"Peyman","family":"Benharash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,5,23]]},"reference":[{"issue":"9672","key":"pone.0301939.ref001","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1016\/S0140-6736(09)60692-9","article-title":"Mitral regurgitation.","volume":"373","author":"M Enriquez-Sarano","year":"2009","journal-title":"The Lancet"},{"issue":"3","key":"pone.0301939.ref002","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1016\/j.athoracsur.2018.03.086","article-title":"Isolated Mitral Valve Surgery: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis.","volume":"106","author":"JS Gammie","year":"2018","journal-title":"Ann Thorac Surg"},{"issue":"19","key":"pone.0301939.ref003","doi-asserted-by":"crossref","first-page":"e018506","DOI":"10.1161\/JAHA.120.018506","article-title":"Degeneration of Bioprosthetic Heart Valves: Update 2020.","volume":"9","author":"AE Kostyunin","year":"2020","journal-title":"JAHA"},{"issue":"19","key":"pone.0301939.ref004","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1056\/NEJMoa1613792","article-title":"Mechanical or Biologic Prostheses for Aortic-Valve and Mitral-Valve Replacement","volume":"377","author":"AB Goldstone","year":"2017","journal-title":"N Engl J Med"},{"issue":"19","key":"pone.0301939.ref005","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.1016\/j.jcin.2017.06.069","article-title":"Transseptal Transcatheter Mitral Valve Replacement Using Balloon-Expandable Transcatheter Heart Valves.","volume":"10","author":"M Urena","year":"2017","journal-title":"JACC Cardiovasc Interv"},{"issue":"2","key":"pone.0301939.ref006","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/j.jtcvs.2018.03.126","article-title":"Outcomes of repeat mitral valve replacement in patients with prior mitral surgery: A benchmark for transcatheter approaches.","volume":"156","author":"JI Ejiofor","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"8","key":"pone.0301939.ref007","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1136\/heartjnl-2017-312047","article-title":"Contemporary outcomes in reoperative mitral valve surgery","volume":"104","author":"HJ Mehaffey","year":"2018","journal-title":"Heart"},{"issue":"1","key":"pone.0301939.ref008","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.athoracsur.2012.08.004","article-title":"Transapical Transcatheter Valve-in-Valve Implantation for Deteriorated Mitral Valve Bioprostheses.","volume":"95","author":"M Wilbring","year":"2013","journal-title":"Ann Thorac Surg."},{"issue":"4","key":"pone.0301939.ref009","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1002\/ccd.29324","article-title":"Surgical redo versus transseptal or transapical transcatheter mitral valve\u2010in\u2010valve implantation for failed mitral valve bioprosthesis.","volume":"97","author":"F Simonetto","year":"2021","journal-title":"Catheter Cardiovasc Interv."},{"issue":"22","key":"pone.0301939.ref010","doi-asserted-by":"crossref","first-page":"e013352","DOI":"10.1161\/JAHA.119.013352","article-title":"Transcatheter Mitral Valve Replacement in the Transcatheter Aortic Valve Replacement Era.","volume":"8","author":"L Testa","year":"2019","journal-title":"J Am Heart Assoc"},{"issue":"5","key":"pone.0301939.ref011","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.jcin.2020.12.038","article-title":"Transcatheter Mitral Valve Replacement: An Update on Current Techniques, Technologies, and Future Directions.","volume":"14","author":"M Hensey","year":"2021","journal-title":"JACC Cardiovasc Interv."},{"issue":"18","key":"pone.0301939.ref012","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1016\/j.jcin.2021.06.014","article-title":"Randomized Trials Are Needed for Transcatheter Mitral Valve Replacement.","volume":"14","author":"JH Rogers","year":"2021","journal-title":"JACC Cardiovasc Interv."},{"issue":"17","key":"pone.0301939.ref013","doi-asserted-by":"crossref","first-page":"e020948","DOI":"10.1161\/JAHA.121.020948","article-title":"Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve in Valve From the National Inpatient Sample.","volume":"10","author":"M Zia Khan","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"pone.0301939.ref014","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.amjcard.2022.04.023","article-title":"In-Hospital Outcomes and Predictors of Mortality for Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve-in-Valve Replacement.","volume":"176","author":"J Gill","year":"2022","journal-title":"Am J Cardiol."},{"key":"pone.0301939.ref015","unstructured":"NRD Overview [Internet]. [cited 2023 Oct 9]. Available from: https:\/\/hcup-us.ahrq.gov\/nrdoverview.jsp"},{"issue":"1","key":"pone.0301939.ref016","first-page":"8","article-title":"Comorbidity Measures for Use with Administrative Data: Medical Care.","volume":"36","author":"A Elixhauser","year":"1998"},{"issue":"6","key":"pone.0301939.ref017","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1097\/MLR.0b013e31819432e5","article-title":"A Modification of the Elixhauser Comorbidity Measures Into a Point System for Hospital Death Using Administrative Data.","volume":"47","author":"C Van Walraven","year":"2009","journal-title":"Medical Care."},{"key":"pone.0301939.ref018","unstructured":"Cost-to-Charge Ratio Files [Internet]. [cited 2023 Oct 9]. Available from: https:\/\/hcup-us.ahrq.gov\/db\/ccr\/costtocharge.jsp"},{"key":"pone.0301939.ref019","unstructured":"Using Appropriate Price Indices for Expenditure Comparisons [Internet]. [cited 2023 Oct 9]. Available from: https:\/\/meps.ahrq.gov\/about_meps\/Price_Index.shtml"},{"issue":"6","key":"pone.0301939.ref020","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.1016\/j.athoracsur.2021.06.025","article-title":"Failure to Rescue: A New Society of Thoracic Surgeons Quality Metric for Cardiac Surgery","volume":"113","author":"PA Kurlansky","year":"2022","journal-title":"The Annals of Thoracic Surgery"},{"issue":"10","key":"pone.0301939.ref021","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1016\/j.amjcard.2018.07.047","article-title":"Comparison of Frequency of Late Gastrointestinal Bleeding With Transcatheter Versus Surgical Aortic Valve Replacement.","volume":"122","author":"A Iyengar","year":"2018","journal-title":"Am J Cardiol."},{"key":"pone.0301939.ref022","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2022\/5688026","article-title":"Declining Trend of Transapical Access for Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis.","volume":"2022","author":"S Sohal","year":"2022","journal-title":"J Interv Cardiol."},{"issue":"1","key":"pone.0301939.ref023","doi-asserted-by":"crossref","first-page":"E153","DOI":"10.1002\/ccd.29379","article-title":"Transcatheter aortic valve replacement in aortic regurgitation: The U.S. experience.","volume":"98","author":"S Arora","year":"2021","journal-title":"Catheter Cardiovasc Interv."},{"issue":"3","key":"pone.0301939.ref024","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1016\/j.jvs.2022.11.044","article-title":"Incidence and predictors of acute limb ischemia in acute myocardial infarction complicated by cardiogenic shock","volume":"77","author":"CM Romero","year":"2023","journal-title":"J Vasc Surg"},{"key":"pone.0301939.ref025","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.avsg.2023.04.004","article-title":"Sex-Related Disparities in Acute Limb Ischemia Treatment Outcomes.","volume":"95","author":"DB Chihade","year":"2023","journal-title":"Ann Vasc Surg."},{"issue":"1","key":"pone.0301939.ref026","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1002\/sim.4780040112","article-title":"A wilcoxon\u2010type test for trend","volume":"4","author":"J. Cuzick","year":"1985","journal-title":"Statistics in Medicine."},{"issue":"1","key":"pone.0301939.ref027","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1111\/j.2517-6161.1996.tb02080.x","article-title":"Regression Shrinkage and Selection Via the Lasso","volume":"58","author":"R. Tibshirani","year":"1996","journal-title":"J R Statist Soc B"},{"issue":"1","key":"pone.0301939.ref028","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1093\/pan\/mpr025","article-title":"Entropy Balancing for Causal Effects: A Multivariate Reweighting Method to Produce Balanced Samples in Observational Studies","volume":"20","author":"J. Hainmueller","year":"2012","journal-title":"Political Analysis."},{"key":"pone.0301939.ref029","volume-title":"Examination of Entropy balancing technique for estimating some standard measures of treatment effects: A simulation study [Internet]","author":"L Amusa","year":"2019"},{"issue":"1","key":"pone.0301939.ref030","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s10742-020-00236-2","article-title":"Nonparametric estimation of population average dose-response curves using entropy balancing weights for continuous exposures.","volume":"21","author":"BG Vegetabile","year":"2021","journal-title":"Health Serv Outcomes Res Method."},{"issue":"3","key":"pone.0301939.ref031","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1002\/ccd.29963","article-title":"Trends in utilization, outcomes, and readmissions after transcatheter mitral valve replacement.","volume":"99","author":"A Elbadawi","year":"2022","journal-title":"Cathet Cardio Intervent."},{"issue":"11","key":"pone.0301939.ref032","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1001\/jamacardio.2020.2974","article-title":"One-Year Outcomes of Mitral Valve-in-Valve Using the SAPIEN 3 Transcatheter Heart Valve.","volume":"5","author":"B Whisenant","year":"2020","journal-title":"JAMA Cardiol"},{"issue":"5","key":"pone.0301939.ref033","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1080\/24748706.2018.1494397","article-title":"Left Ventricular Outflow Tract Obstruction Following Mitral Valve Replacement: Challenges for Transcatheter Mitral Valve Therapy.","volume":"2","author":"AW Asgar","year":"2018","journal-title":"Structural Heart"},{"issue":"3","key":"pone.0301939.ref034","doi-asserted-by":"crossref","first-page":"e008425","DOI":"10.1161\/CIRCINTERVENTIONS.119.008425","article-title":"Thirty-Day Outcomes of Transcatheter Mitral Valve Replacement for Degenerated Mitral Bioprostheses (Valve-in-Valve), Failed Surgical Rings (Valve-in-Ring), and Native Valve With Severe Mitral Annular Calcification (Valve-in-Mitral Annular Calcification) in the United States: Data From the Society of Thoracic Surgeons\/American College of Cardiology\/Transcatheter Valve Therapy Registry.","volume":"13","author":"M Guerrero","year":"2020","journal-title":"Circ Cardiovasc Interv."},{"issue":"5","key":"pone.0301939.ref035","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1093\/eurheartj\/ehy590","article-title":"Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification","volume":"40","author":"SH Yoon","year":"2019","journal-title":"Eur Heart J"},{"issue":"20","key":"pone.0301939.ref036","doi-asserted-by":"crossref","first-page":"2521","DOI":"10.1016\/j.jacc.2019.02.076","article-title":"Anterior Leaflet Laceration to Prevent Ventricular Outflow Tract Obstruction During Transcatheter Mitral Valve Replacement","volume":"73","author":"JM Khan","year":"2019","journal-title":"J Am Coll Cardiol"},{"issue":"17","key":"pone.0301939.ref037","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1016\/j.jacc.2018.02.054","article-title":"1-Year Outcomes of Transcatheter Mitral Valve Replacement in Patients With Severe Mitral Annular Calcification","volume":"71","author":"M Guerrero","year":"2018","journal-title":"J Am Coll Cardiol"},{"issue":"8","key":"pone.0301939.ref038","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1016\/j.jcin.2023.01.357","article-title":"Emerging Approaches to Management of Left Ventricular Outflow Obstruction Risk in Transcatheter Mitral Valve Replacement.","volume":"16","author":"MF Eleid","year":"2023","journal-title":"JACC Cardiovasc Interv."},{"issue":"6","key":"pone.0301939.ref039","doi-asserted-by":"crossref","first-page":"724","DOI":"10.21037\/acs.2018.10.06","article-title":"Complexities of transcatheter mitral valve replacement (TMVR) and why it is not transcatheter aortic valve replacement (TAVR).","volume":"7","author":"MCW von Ballmoos","year":"2018","journal-title":"Ann Cardiothorac Surg."},{"key":"pone.0301939.ref040","article-title":"A Decade Later, Continued Transformation of Transcatheter Aortic Valve Replacement.","author":"MN Young","year":"2018","journal-title":"US Cardiology Review 2018;12(1):28\u201332 [Internet]."},{"issue":"9","key":"pone.0301939.ref041","doi-asserted-by":"crossref","first-page":"e010628","DOI":"10.1161\/CIRCINTERVENTIONS.121.010628","article-title":"Transcatheter Mitral Valve Implantation: Current Status and Future Perspectives.","volume":"14","author":"G Russo","year":"2021","journal-title":"Circ Cardiovasc Interv."},{"issue":"3","key":"pone.0301939.ref042","first-page":"e011295","article-title":"Contemporary Costs Associated With Transcatheter Versus Surgical Aortic Valve Replacement in Medicare Beneficiaries.","volume":"15","author":"SJ Baron","year":"2022","journal-title":"Circ: Cardiovascular Interventions."},{"issue":"6","key":"pone.0301939.ref043","doi-asserted-by":"crossref","first-page":"1954","DOI":"10.1016\/j.athoracsur.2012.07.002","article-title":"Costs of Transcatheter Versus Surgical Aortic Valve Replacement in Intermediate-Risk Patients.","volume":"94","author":"RLJ Osnabrugge","year":"2012","journal-title":"Ann Thorac Surg."},{"issue":"1","key":"pone.0301939.ref044","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.athoracsur.2015.05.120","article-title":"Contemporary Costs Associated With Transcatheter Aortic Valve Replacement.","volume":"101","author":"G Ailawadi","year":"2016","journal-title":"Ann Thorac Surg."},{"issue":"11","key":"pone.0301939.ref045","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1016\/j.jcin.2016.04.006","article-title":"Transseptal Instead of Transapical Valve Implantation.","volume":"9","author":"D. Dvir","year":"2016","journal-title":"JACC Cardiovasc Interv."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0301939","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T17:52:08Z","timestamp":1716486728000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0301939"}},"subtitle":[],"editor":[{"given":"George C. M.","family":"Siontis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,5,23]]},"references-count":45,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0301939","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,23]]}}}