ObjectivesWe performed a meta‐analysis of transcatheter mitral valve implantation (TMVI) for deteriorated bioprosthetic valves (valve‐in‐valve [VIV]‐TMVI) and/or failed annuloplasty rings (valve‐in‐ring [VIR]‐TMVI), comparing observed early (30‐day) mortality with predicted operative mortality.BackgroundIt remains unclear whether VIV/VIR‐TMVI reduces mortality as compared with redo MVS.MethodsMEDLINE and EMBASE were searched current through 24 July 2018 using Web‐based search engines (PubMed and OVID) to identify studies including ≥10 patients undergoing VIV/VIR‐TMVI. For each study, data regarding observed 30‐day mortality and predicted operative mortality (Society of Thoracic Surgeons Predicted Risk of Mortality [STS‐PROM]) were used to generate risk ratios (RRs) and 95% confidence intervals (CIs). Study‐specific estimates were combined using the inverse variance‐weighted average of logarithmic RRs in the random‐effects model. One‐group meta‐analyses of 30‐day/late (including 30‐day) mortality rates were also performed in the random‐effects model.ResultsOf 270 potentially relevant articles screened initially, 17 eligible studies including a total of 1017 patients undergoing VIV/VIR‐TMVI were identified. In all but four studies, the STS‐PROM was available and varied from 7.7% to 22.0% (weighted mean, 11.5%). Pooled analyses of all VIV/VIR‐TMVI studies demonstrated the 30‐day mortality rate of 5.4% (95%CI, 4.0‐6.8%), the midterm (1‐ to 5‐year) mortality rate of 13.7% (95%CI, 9.0‐18.5%), and significantly lower observed 30‐day mortality than predicted operative mortality (RR, 0.67; 95%CI, 0.49‐0.91; P = 0.01).ConclusionsVIV/VIR‐TMVI brought about relatively low early and midterm (1‐ to 5‐year) mortality, and observed 30‐day mortality was significantly lower than predicted operative mortality.