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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
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'CLAS' score: an objective tool to standardize and predict mitral valve repairability

Amber Malhotra1, Sumbul Siddiqui1, Vivek Wadhawa1

  • 1Department of Cardio Vascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center (affiliated to BJ Medical College, Ahmedabad), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India.

Indian Journal of Thoracic and Cardiovascular Surgery
|October 16, 2020
PubMed

Insights

The CLAS score effectively predicts mitral valve repair success. A score of 8 or less indicates a high likelihood of successful repair, guiding surgical decisions.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery
  • Valvular Heart Disease

Background:

  • Carpentier's classification lacks universal applicability for mitral valve disease complexity and repair prognosis.
  • A need exists for a standardized nomenclature to assess mitral valve lesions and guide repair strategies.

Purpose of the Study:

  • To introduce and validate the CLAS (Commissures, Leaflet, Annulus, Subvalvular apparatus) scoring system.
  • To identify predictors of mitral valve repairability using the CLAS score.

Main Methods:

  • Prospective study of 394 patients undergoing mitral valve procedures.
  • Division of the valvular apparatus into four subunits (C, L, A, S) for scoring.
  • Formulation of three CLAS groups based on calculated scores.

Main Results:

  • Successful mitral valve repair (MVRep) in 95.43% of 376 patients.
  • 100% repair success for CLAS score ≤ 8, compared to 93.33% (9-12) and 69.69% (>12).
  • Correlation found between CLAS groups and cardiopulmonary bypass time, aortic-cross-clamp time, and ICU stay.

Conclusions:

  • The CLAS score is a strong predictor of successful mitral valve repair.
  • Recommend attempting repair for all patients with a CLAS score ≤ 8.
  • Refer patients with CLAS scores > 8 to specialized repair centers.
Abstract

Keywords:
Mitral regurgitationMitral valve repairRheumatic heart disease

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