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Updated: Jan 10, 2026
08:31
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
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Early Outcomes and Risk Factors Associated With Second Cross-clamping in Mitral Valve Repair: A Propensity-matched
Serdar Akansel1,2, Martina Dini1,2, Leonard Pitts1,2,3
1Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin 13353, Germany.
Summary
Second cross-clamping (2nd XCL) during minimally invasive mitral valve repair (MI-MVr) is uncommon but safe. Complex valve issues in degenerative or functional mitral regurgitation increase the risk for 2nd XCL, though outcomes remain comparable.
Area of Science:
- Cardiac Surgery
- Mitral Valve Repair
- Minimally Invasive Cardiac Surgery
Background:
- Second cross-clamping (2nd XCL) during mitral valve repair (MVr) is infrequently needed, often due to initial repair inadequacy.
- Minimally invasive MVr (MI-MVr) offers benefits but requires careful assessment of factors necessitating re-exploration.
Purpose of the Study:
- To identify risk factors associated with requiring 2nd XCL during MI-MVr.
- To compare early and mid-term outcomes between patients undergoing single vs. 2nd XCL in MI-MVr using propensity matching.
Main Methods:
- Retrospective review of 1732 patients undergoing MI-MVr for degenerative mitral regurgitation (DMR) or functional mitral regurgitation (FMR).
- 1:1 propensity matching of patients with single vs. 2nd XCL based on key baseline characteristics.
- Analysis of echocardiographic data, surgical techniques, and postoperative outcomes; logistic regression for predictors and Kaplan-Meier for survival.
Main Results:
- 76 patients (4.4%) required 2nd XCL, primarily due to residual mitral regurgitation (MR).
- Complex valve pathology in DMR and leaflet restriction in FMR were associated with higher 2nd XCL rates.
- The 2nd XCL group experienced longer cardiopulmonary bypass and aortic cross-clamp times, with prolonged ventilation and ICU stay, but showed no significant difference in mid-term survival.
Conclusions:
- 2nd XCL during MI-MVr is a safe procedure that does not compromise early or mid-term postoperative outcomes.
- Patients with complex DMR and FMR involving leaflet restriction face an elevated risk of requiring 2nd XCL.
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