Impact of Failed Mitral Clipping on Subsequent Mitral Valve Operations

Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short‐ and Long‐Term Outcomes in a Propensity‐Matched Cohort

“…The missing component of annuloplasty in MitraClip ™ procedures may therefore be one cause of recurrent MR. Moreover, MitraClip ™ therapy can complicate future MV‐repair, as valves after failed MitraClip ™ procedures are often not repairable, especially if more than one clip has been placed 24. We therefore conclude that elderly patients with degenerative MR and acceptable surgical risk should undergo surgery as the initial “gold standard” treatment.…”

“…Moreover, MitraClip TM therapy can complicate future MV-repair, as valves after failed MitraClip TM procedures are often not repairable, especially if more than one clip has been placed. 24 We therefore conclude that elderly patients with degenerative MR and acceptable surgical risk should undergo surgery as the initial "gold standard" treatment. Transcatheter mitral valve-in-ring implantation might still be an option should a repaired valve fail, provided that the implanted ring is not dehiscent and adaptable to circular shape.…”

Intraprocedural assessment of mitral regurgitation during the mitraclip procedure: Impact of continuous left atrial pressure monitoring

“…In normal risk patients, however, the efficacy of the Mitra-Clip procedure in reducing mitral regurgitation was inferior to surgical treatment when compared in a randomized clinical trial [8]. Whether this translates into a worse clinical outcome of MitraClip patients is an ongoing controversial issue [4,[9][10][11]. The EVEREST trial included, in the majority of cases, patients with primary MR and was done at an early stage of the development of the MitraClip procedure.…”

Association of Uneven MitraClip Application and Leaflet Stress in a Finite Element Model

“…Uneven MitraClip application is a common procedural occurrence, resulting in more posterior than anterior leaflet tissue grasped by the clip (2). To determine whether uneven clipping plays a role in MR recurrence, we investigated the effect of MitraClip application on leaflet stress, which is implicated in repair failure: Leaflets excised after failed MitraClip show significant tissue damage, including large perforations; (3) Furthermore, in-vitro studies have shown that increased leaflet stress alters collagen and proteoglycan synthesis, resulting in leaflet thickening and increased compliance. (4, 5) Leaflet stress resulting from uneven clip application has not been previously studied.…”