Failed MitraClip therapy: surgical revision in high-risk patients

Abstract

Background MitraClip implantation is a valid interventional option that offers acceptable short-term results. Surgery after failed MitraClip procedures remains challenging in high-risk patients. The data on these cases are limited by the small sample numbers. Aim The aim of our study is to show, that mitral valve surgery could be possible and more advantageous, even in high-risk patients. Methods Between 2010 and 2016, nine patients underwent mitral valve surgery after failed MitraClip therapy at our institution. Results The patients’ ages ranged from 19 to 75 years (mean: 61.2 ± 19.6 years). The median interval between the MitraClip intervention and surgical revision was 45 days (range: 0 to 1087 days). In eight of nine patients, the MitraClip intervention was initially successful and the mitral regurgitation was reduced. Only one patient had undergone cardiac surgery previously. Intra-operatively, leaflet perforation or rupture, MitraClip detachment, and chordal or papillary muscle rupture were potentially the causes of recurrent mitral regurgitation. There were three early deaths. One year after surgery, the six remaining patients were alive. Conclusions Mitral valve surgery can be successfully performed after failed MitraClip therapy in high-risk patients. The initial indication for MitraClip therapy should be considered carefully for possible surgical repair.

Surgical revision after percutaneous mitral valve repair by edge‐to‐edge device in high‐risk patients

“…The main finding of this study is the feasibility of mitral valve surgery in a highest risk patient cohort with a predominantly complex constellation of mixed degenerative/functional MR and significantly reduced left ventricular ejection fraction who were initially classified as high surgical risk and, therefore, inoperable (Table 2). Our results are in line with recent publications on post‐MC surgical bailout, in which feasibility of surgery with acceptable results were equally demonstrated 9,10 . Organ failure resulting from cardiogenic shock/sepsis as possible risk factor for perioperative mortality in our case and in the patient‐cohort recently presented by Takayuki et al 10 calls for close meshed monitoring of these patients and timely surgery if indicated and feasible.…”

“…This approach is supported by the fact that the overall impact of MC in secondary MR is yet to be irrevocably established 8 . Publications dealing with persistent or recurrent MR after MC intervention and subsequent management strategies in this often times difficult situation are increasing and need to be evaluated to better understand the future perspectives of catheter‐based MV intervention 9,10 . Factors guiding the decision as to whether to treat a case of failed MC intervention conservatively, catheter‐based or surgically is yet to be fully established.…”

“…8 Publications dealing with persistent or recurrent MR after MC intervention and subsequent management strategies in this often times difficult situation are increasing and need to be evaluated to better understand the future perspectives of catheterbased MV intervention. 9,10 Factors guiding the decision as to whether to treat a case of failed MC intervention conservatively, catheter-based or surgically is yet to be fully established. Therefore interdisciplinary heart-team approach should be of paramount importance in this early phase of a new technology.…”

Reinterventions after transcatheter edge to edge mitral valve repair: Is early clipping warranted?

“…Surgical intervention either by repairing or replacing the MV will stand as an option in such situation alternative to the repeated clipping, especially in situations with acute failure, like leaflets detachment, or severe uncontrollable MR caused by leaflet perforation, in addition to hemodynamic compromise. 6 Studies evaluating reinterventions after MitraClip are scarce, and the management plan for this particular patient category is not well-established. In this study, we aimed to report our experience in reinterventions after MitraClip procedures and describe the outcomes.…”

“…Surgical intervention either by repairing or replacing the MV will stand as an option in such situation alternative to the repeated clipping, especially in situations with acute failure, like leaflets detachment, or severe uncontrollable MR caused by leaflet perforation, in addition to hemodynamic compromise 6 …”