Incidence and short‐term outcomes of surgical bailout after transcatheter mitral valve repair with the MitraClip system

Abstract

Objectives This study sought to investigate the incidence and outcomes of surgical bailout (SB) after transcatheter mitral valve repair (TMVr) with MitraClip. Background TMVr poses a risk of serious procedural complications, possibly requiring urgent open surgery for SB. However, little is known about the risk of SB cases after TMVr. Methods We retrospectively identified patients who underwent TMVr using the Nationwide Readmissions Database 2014–2017. SB was defined as open thoracotomy for heart and aorta during the same hospitalization. Annual hospital volume was defined as the annual number of TMVr cases in each hospital in each year. Results Among 15,032 eligible patients, SB was required in 214 (1.42%), of whom 134 (62.6%) underwent mitral valve surgery (113 replacements; 21 repairs). The incidence of SB was decreasing significantly over the 4 years (5.26% in 2014; 0.43% in 2017; ptrend < .001). There was a significant nonlinear, inverse association of annual hospital volume with the incidence of SB. In‐hospital death (15.0 vs. 2.1%; p < .001) and other in‐hospital adverse events were significantly more frequent in patients with than without SB, whereas the 30‐day readmission rate was similar (13.2 vs. 15.1%; p = .572). After adjustment for patient and hospital characteristics, SB was significantly associated with higher in‐hospital mortality (odds ratio = 6.67, 95% confidence interval = 4.35, 10.23, p < .001). Conclusions This study suggests that although the incidence of SB after TMVr is decreasing, SB is required more frequently in lower‐volume hospitals and carries high in‐hospital mortality. Further efforts are needed to understand the reasons for SB and improve outcomes in patients needing SB.

Transcatheter mitral valve repair and replacement. Expert consensus statement of the Polish Cardiac Society and the Polish Society of Cardiothoracic Surgeons

“…When implanting the Carillon device, it should be remembered that perforation of the thin-walled coronary sinus is a possible procedural complication and that in some patients, the circumflex coronary artery may be compressed with subsequent flow obstruction. For the above reasons, 14% of patients were not implanted with Carillon in the REDUCE-FMR study [28]. Indirect mitral annuloplasty using Carillon is an effective treatment method that reduces MR and results in favorable left ventricular remodeling.…”

How often is urgent surgery required to address transcatheter mitral valve repair complications?

“…In this issue of Catheterization and Cardiovascular Interventions , Isogai et al 2 searched the Nationwide Readmissions Database to determine the incidence of bailout surgery for patients who underwent MitraClip therapy in the United States from 2014 to 2017. During this period, 1.42% of patients who underwent TMVr required surgical bailout.…”