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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
PubMed
Abstract

Insights

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 surgery

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