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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
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Mitral Valve Surgery After Failed MitraClip: A Single-Center Experience
Florian Rader1, Robert J Siegel, Nir Flint
1Smidt Heart Institute, Cedars-Sinai Medical Center, 127 San Vincente Blvd, AHSP A3408, Los Angeles, CA 90048 USA. Florian.Rader@cshs.org.
The Journal of Invasive Cardiology
|April 1, 2021
Summary
Surgical mitral valve repair is feasible for patients experiencing recurrent mitral regurgitation after MitraClip failure. This approach is important for preserving long-term outcomes in selected patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Percutaneous mitral repair using MitraClip is a safe option for high-risk patients with degenerative or functional mitral regurgitation.
- A subset of patients undergoing MitraClip may require subsequent mitral surgery due to recurrent significant mitral regurgitation.
Purpose of the Study:
- To evaluate the feasibility and outcomes of surgical mitral valve (MV) repair in patients with recurrent mitral regurgitation (MR) following a failed MitraClip procedure.
- To assess candidacy for surgical MV repair after transcatheter mitral repair failure.
Main Methods:
- An observational study including consecutive patients who underwent mitral surgery after MitraClip failure.
- Analysis of patient demographics, surgical procedures (repair vs. replacement), reasons for replacement, and perioperative outcomes.
Main Results:
- Twenty-five patients with severe symptomatic MR post-MitraClip underwent surgery; 10 had MV repair and 15 had MV replacement.
- MitraClip-related leaflet damage, advanced age, endocarditis, and severe leaflet calcification/rheumatic disease were reasons for MV replacement.
- Perioperative complications were infrequent, and intermediate-term mortality was similar between the repair and replacement groups (30% vs. 27%, P=.90).
Conclusions:
- Surgical mitral valve repair is a viable option for patients with failed MitraClip, particularly when performed by experienced surgeons within one year of the initial procedure.
- Preserving the option for surgical repair after MitraClip failure is crucial for optimizing long-term outcomes, especially as transcatheter interventions target lower-risk populations.
- MitraClip-related leaflet damage can preclude repair, necessitating valve replacement in some cases.
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