SURVIV Investigates Mitral Valve-in-Valve Procedure for Bioprosthetic Mitral Valve Dysfunction

April 3, 2026—Findings from the SURVIV trial showed that in patients with bioprosthetic mitral valve dysfunction, a transcatheter mitral valve-in-valve procedure (mVIV) to insert a new valve was associated with a lower rate of death or disabling stroke within 1 year, compared with patients who underwent standard redo mitral valve replacement surgery (rMVR).

The SURVIV study was presented by Principal Investigator Dimytri Siqueira, MD, at ACC.26, the American College of Cardiology’s annual scientific session. Dr. Siqueira is Chief of Interventions in the Acquired Valvular Heart Disease section at the Dante Pazzanese Institute of Cardiology in São Paulo, Brazil.

According to ACC, the investigator-initiated SURVIV trial enrolled 150 patients (average age, 58 years; 72% women) at seven centers in Brazil. Many patients in the study had underlying rheumatic valve disease, which is a common cause of mitral valve disease in middle- and low-income countries that often leads to valve replacement at a younger age and increases the likelihood of subsequent interventions.

Dr. Siqueira noted that in Brazil, rheumatic valvular heart disease is still common and patients often undergo their first mitral valve surgery in their 30s or 40s and need a second replacement valve surgery 10 to 15 years later. In the United States, by contrast, the average age for a first mitral valve surgery is approximately 64 years and many patients may need a repeat surgery in their 70s or 80s.

As noted in the ACC press release, all patients in the SURVIV study were considered suitable candidates for both repeat open heart surgery and the mVIV procedure; 70% had high blood pressure in their lungs; 50% had atrial fibrillation; approximately 25% previously had undergone more than one mitral valve surgery.

ACC advised that patients were randomly assigned to receive a new mitral valve via either mVIV or rMVR.

The study’s primary endpoint was a composite of death from any cause and disabling stroke at 1 year. Key secondary endpoints included major complications such as death from heart disease or a stroke, major bleeding, and kidney failure.

The investigators found that primary endpoint at 1 year occurred in 20.8% of patients assigned to rMVR and in 5.3% of those treated with mVIV. Dr. Siqueira reported that this difference was largely driven by events occurring in the early postoperative period: in-hospital deaths were higher in the surgical group (12.5% vs 0%). Additionally, acute kidney injury and life-threatening or major bleeding complications were more frequently observed after surgery. Stroke rates were low in both groups.

The investigators plan to follow the patients in the study for a total of 10 years, noted the ACC press release.

“These results suggest that a transcatheter valve-in-valve procedure may offer an important short-term clinical benefit in selected high-risk patients,” commented Dr. Siqueira in the ACC press release. “However, long-term follow-up of patient outcomes is essential to better understand durability and the overall role of this approach in clinical practice.”