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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-Operation for the inoperable?
Stephen Gerfer1, Borko Ivanov1, Clara Großmann1
1Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany.
Journal of Cardiac Surgery
|July 17, 2022
Summary
MitraClip failure in high-risk patients necessitates complex reoperation, often resulting in mitral valve replacement. While outcomes are challenging, careful patient selection for MitraClip is crucial.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Heart Valve Disease
Background:
- Percutaneous edge-to-edge mitral valve repair (MitraClip) is a key treatment for mitral regurgitation (MR) in high-risk patients.
- Limited data exists on outcomes for the highest-risk surgical candidates undergoing MitraClip.
- MitraClip failure or recurrent MR predicts poor survival, making reoperation a critical consideration.
Purpose of the Study:
- To evaluate outcomes of open mitral valve surgery following MitraClip failure in a high-risk cohort.
- To identify challenges and complications associated with reoperation after MitraClip.
- To emphasize the importance of patient selection for initial MitraClip procedures.
Main Methods:
- Retrospective single-center cohort study of 17 patients undergoing mitral valve surgery after MitraClip failure.
- Analysis of high-risk patients (EuroSCORE II = 10 ± 2.0) with persistent MR due to device detachment or dislocation.
- Assessment of procedural characteristics, mortality, complications, and echocardiographic results.
Main Results:
- Reoperations were complex, often requiring concomitant procedures, with a mean time to surgery of 23 ± 44 days.
- 30-day all-cause mortality was 18% (3/17), with prolonged mechanical ventilation and ICU stay.
- Valve-related mortality was 6% (1/17), and moderate/severe paravalvular leak occurred in 6% (1/17).
Conclusions:
- MitraClip failure in high-risk patients presents a significant challenge, frequently necessitating mitral valve replacement (94%).
- Secondary surgery is associated with moderate 30-day and postdischarge outcomes.
- Meticulous pre-procedural patient evaluation for MitraClip is essential to optimize outcomes and avoid reoperation.
Keywords:
MitraClipmitral valve repairmitral valve replacementmitral valve surgerypercutaneous edge-to-edge mitral valve repairre-do mitral valve surgeryMore Related Videos
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