Mitral Valve Surgery in 6 Patients after Failed MitraClip Therapy

Abstract

The MitraClip percutaneous mitral valve repair system, developed as an option for percutaneous mitral repair, was clinically introduced in 2007. From 2010 through 2012, 6 of our patients underwent mitral valve surgery after MitraClip failure. Their mean age was 75 ± 7.7 years (range, 62–87 yr). Three had undergone cardiac surgery previously. In 5 of the 6 patients, mitral regurgitation recurred after initially successful MitraClip deployment and was the indication for surgery. The mean interval between MitraClip implantation and surgery was 106 ± 86 days (range, 0–238 d). Mitral valve repair was feasible in 3 patients; the others underwent valve replacement. All the patients underwent additional cardiac procedures, because the MitraClip worsened existing conditions. Echocardiograms revealed sufficient valvular repairs. Two patients died during hospitalization, one of cerebral infarction and the other of bowel ischemia. Mitral valve repair after failed MitraClip therapy can be complex and a surgical challenge. Careful consideration should be given to appropriate patient selection for MitraClip therapy, because the MitraClip can cause existing pathologic valvular conditions to deteriorate substantially. The interval between MitraClip failure and corrective surgery should be as short as possible. The primary indication is an issue of ongoing discussion.

Outcomes and Predictors of Mortality After Mitral Valve Surgery in High-Risk Elderly Patients: The Heidelberg Experience

“…In our study group surgical revision was performed in five cases after failed MitraClip with acceptable survival (one death nine days after surgery). Such experiences were reported with comparable results [ 25 , 26 ]. Nevertheless, mitral valve surgery after failed interventional procedures remains complex and presents surgical challenges.…”

Mitral valve surgery following failed MitraClip implantation

“…Patients with degenerative MR had better results when treated initially with surgery; however, MCI failure, functional MR, patient age, previous cardiac surgery, surgeon experience, and time interval between MCI and surgery were not identified as risk factors for valve replacement rather than repair . Furthermore, clip implantation did not lead to any significant progression of degenerative or functional MR other than structural damage to valvular apparatus, such as chordal damage, whose tear led to worsening leaflet prolapse and aggravated MR …”

“…In one case, the bioprosthetic transcatheter valve and an Amplatzer device had to be surgically removed . In four patients (4%), the MV had to be replaced after MCI due to infective endocarditis causing severe MR …”

“…On the other hand, Monsefi et al reported two cases of native MV leaflets fibrosis and fusion, which made repair impossible, with no renal failure present . The pathological healing response to MitraClip was investigated by Ladich and colleagues .…”

Infective endocarditis following transcatheter edge‐to‐edge mitral valve repair: A systematic review

“…A total of 10 publications describing 12 cases of IE following percutaneous edge-to-edge mitral valve repair were identified [8][9][10][11][12][13][14][15][16][17]. All cases were published between 2011 and 2017.…”