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Is Surgical or Catheter-based Interventions an Option After an Unsuccessful Mitral Clip?

Felix Kreidel1, Hannes Alessandrini1, Peter Wohlmuth2

  • 1Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.

Seminars in Thoracic and Cardiovascular Surgery
|March 17, 2018
PubMed

Insights

Repeat MitraClip therapy and mitral valve surgery are safe options for patients with primary mitral regurgitation after initial MitraClip failure. Both approaches improved patient symptoms and heart function, with surgery being more definitive when leaflet insertion is compromised.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • MitraClip therapy is a transcatheter treatment for mitral regurgitation.
  • Failure of the initial MitraClip procedure can necessitate reintervention.
  • Primary mitral regurgitation requires effective management to prevent adverse cardiac remodeling and symptoms.

Purpose of the Study:

  • To evaluate the outcomes of catheter-based and surgical reinterventions for primary mitral regurgitation following failed MitraClip therapy.
  • To compare the effectiveness and safety of repeat MitraClip procedures versus mitral valve surgery in this patient cohort.

Main Methods:

  • Retrospective analysis of 21 consecutive symptomatic patients with primary mitral regurgitation.
  • Patients underwent either repeat MitraClip therapy (n=7) or mitral valve surgery (n=14) after index MitraClip failure.
  • Clinical outcomes, including mortality, symptom severity (New York Heart Association class), and cardiac dimensions, were assessed post-reintervention.

Main Results:

  • Early mortality was 4.8%, with 2-year cardiac-related survival at 85.4%.
  • Significant improvement in New York Heart Association class (median 2) and left ventricular end-diastolic diameter (decreased to 51 mm) was observed at follow-up.
  • Repeat MitraClip was effective in some cases, but 3 patients required conversion to surgery due to clip detachment or leaflet tear. Mitral valve replacement was the final therapy in 66.7% of patients.

Conclusions:

  • Both repeat transcatheter MitraClip repair and mitral valve surgery are feasible and safe reintervention strategies for primary mitral regurgitation after initial MitraClip failure, provided perioperative risk is not excessively high.
  • Repeat catheter-based repair is a viable option when leaflet insertion remains intact.
  • Surgical intervention should be considered for patients with compromised leaflet integrity or when repeat transcatheter repair is unsuccessful.
Keywords:
MitraClipmitral regurgitationmitral valveprimary mitral valve disease

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