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

Abstract

Background: Reintervention after transcatheter edge to edge repair using MitraClip is still challenging. We aimed to report our experience in reinterventions after MitraClip procedures and describe the outcomes. Methods: From 2012 to 2020, 167 patients had a transcatheter edge to edge repair; 10 of them needed reinterventions. At the time of the first MitraClip, the median EuroSCORE was 4.29 (2.62-7.52), and the ejection fraction was 30 (20-40)%. Results: Emergency mitral valve replacement (MVR) was performed in two patients, elective MVR in three, cardiac transplantation in two, and repeat clipping in threepatients. The median time from MitraClip to the reintervention was 4.5 (2-13) months. One patient required extracorporeal membrane oxygenation support after elective MVR. Repeat clipping failed to control mitral regurgitation grade in all patients. Clip detachment was reported in five patients (50%). The median follow-up after the reintervention was 19.5 (9-75) months, and mortality occurred in two patients who had repeat clipping (20%). Conclusions: MVR after MitraClip is feasible with low morbidity and mortality. Repeat mitral valve clipping had a high failure rate. Mitral repair was not feasible in all patients in our series, and the use of MitraClip to delay surgical interventions may not be feasible if mitral repair is an option.

Procedural and clinical outcomes after repeat edge‐to‐edge transcatheter mitral valve repair

“…In some cases, these residual MR are not present after the initial procedure and show up during the follow‐up period. Progressive left ventricle remodeling, leaflet perforation or partial detachment have been described as potential mechanisms for MR progression after edge‐to‐edge repair 12‐19 . Repeated edge‐to‐edge TMVR procedures have been proposed as a valid strategy for correcting some residual MRs 12‐19 .…”

“…Progressive left ventricle remodeling, leaflet perforation or partial detachment have been described as potential mechanisms for MR progression after edge‐to‐edge repair 12‐19 . Repeated edge‐to‐edge TMVR procedures have been proposed as a valid strategy for correcting some residual MRs 12‐19 . However, evidence regarding redo TMVR for recurrent mitral regurgitation is scarce 14 .…”

Residual versus recurrent mitral regurgitation after transcatheter mitral valve edge‐to‐edge repair

“…The number of patients treated with transcatheter mitral valve repair is growing rapidly. Consequently, the number of patients with residual or recurrent MR is increasing 5,6 . These patients with residual or recurrent MR were deemed high risk for surgical repair and failed medical therapy as the first treatment line.…”

“…Consequently, the number of patients with residual or recurrent MR is increasing. 5,6 These patients with residual or recurrent MR were deemed high risk for surgical repair and failed medical therapy as the first treatment line. The characteristic and optimal management of those patients after MitraClip has not been thoroughly evaluated.…”

“…groups and most patients in the recurrent MR group had cardiomyopathy and functional MR.The learning curve of the operators performing the MitraClip procedure and the heart team selecting the proper candidate played a role in the adverse outcome since the rate of acute failure was the highest at the beginning of the treatment program 6. Two patients in the residual MR group had a failure to deploy the clips and had emergency surgical interventions because of clip or leaflet detachment.…”