Repeated MitraClip procedure in patients with recurrent MR after a successful first procedure: Limitations and outcome

Curio, Jonathan; Reinthaler, Markus; Kasner, Margaret; Al-Hindwan, Haitham Saleh Ali; Baeckemo-Johansson, Johan; Neumann, Tim; Jacobs, Stephan; Lauten, Alexander; Landmesser, Ulf

doi:10.1111/joic.12457

Cited by 9 publications

(19 citation statements)

References 27 publications

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“…5,6,[29][30][31] Correspondingly to this rare realization, only Re-do MitraClip in advanced heart failure two case series of 16 and 21 patients, respectively, with mixed aetiology of MR, functional (71% and 53%, respectively), and degenerative (29% and 47%, respectively) at first intervention have been published so far on this subject. 12,29 Although cardiac function was superior to our study and LV diameters were smaller, in the other two series, the overall procedural success rates were only 62% and 73%, respectively, for the re-do MitraClip intervention. 12,29 In our study, the success rate was comparable with this (65%).…”

Section: General Considerations For Re-do Mitraclip Procedurescontrasting

confidence: 53%

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Re‐do MitraClip in patients with functional mitral valve regurgitation and advanced heart failure

et al. 2021

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Aim Percutaneous mitral valve repair (PMVR) via MitraClip implantation is a therapeutic option for severe mitral regurgitation (MR) in advanced stages of heart failure (HF). However, progressive left ventricular dilation in these patients may lead to recurrent MR after PMVR and consequent re-do MitraClip implantation. Here, we describe the characteristics and outcomes of this clinical scenario. Methods and resultsPatients with systolic HF and functional MR undergoing a re-do MitraClip procedure were retrospectively analysed. Inclusion criteria were age ≥18 years, technical, device and procedural success at first MitraClip procedure, functional MR and systolic HF with an ejection fraction (EF) of <45%. Seventeen out of 684 patients undergoing PMVR with the MitraClip device at our institution between September 2009 and July 2019 were included. All patients displayed advanced HF with an EF of 20% (±9.9) and highly elevated N-terminal pro-brain natriuretic peptide. Technical success of the re-do MitraClip procedure was 100%, whereas procedural and device success were only achieved in 11 patients (65%). Unsuccessful re-do procedures were related to lower EF and implantation of more than one clip at initial procedure. However, despite reduction in MR grade and no occurrence of significant mitral stenosis after the procedure, the mortality during 12 months follow-up remained high (8 of 17; 47%). Conclusions In a cohort of patients with advanced HF undergoing PMVR, re-do MitraClip procedure was feasible, but procedural success was unsatisfactory and morbidity and mortality remained high, possibly reflecting the advanced stage of HF in these patients.

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Section: General Considerations For Re-do Mitraclip Procedurescontrasting

confidence: 53%

“…Data on feasibility and outcomes of re‐do MitraClip procedure are very limited and have not been explicitly elaborated for patients with HF. 12 , 13 Here, we evaluated procedural data and outcomes after re‐do PMVR with focus on patients with advanced HF.…”

Section: Introductionmentioning

confidence: 99%

Re‐do MitraClip in patients with functional mitral valve regurgitation and advanced heart failure

et al. 2021

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“…In this series published in JOIC, the etiology of MR was equally divided between functional and degenerative types; 47% of patients had LLI. 9 Overall, ReClip success rates were similar, 60% at 1 year, compared to that noted by Kreidel et al However, the presence of LLI was not associated with poor outcomes. Whether the differing methods of evaluation of LLI, as described, may be the reason, better understanding the modes of failure for this patient population becomes even more important as we try to better understand the ReClip procedure and methods to improve procedural success.…”

Section: Long-term Outcomes: Does It Compare To Surgery?supporting

confidence: 70%

“…In this series published in JOIC, the etiology of MR was equally divided between functional and degenerative types; 47% of patients had LLI . Overall, ReClip success rates were similar, 60% at 1 year, compared to that noted by Kreidel et al However, the presence of LLI was not associated with poor outcomes.…”

Section: Introductionmentioning

confidence: 47%

“…Nonetheless, with increasing applications of this technology and the growing number of procedures performed, treatment options for recurrent MR is becoming more and more relevant. Curio et al critically evaluated their series of patients over the last 6 years and describe their experience of recurrent MR after successful MitraClip implantation and their ability to perform repeated MitraClip procedures on the same patient, termed “ReClip.”…”

Section: Introductionmentioning

confidence: 99%

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Editorial: Just clip it, then ReClip it again: Expanding populations for transcatheter mitral repair and options for recurrent mitral regurgitation

Kliger

2018

J Interven Cardiology

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

Freixa

Estévez‐Loureiro

Pascual

et al. 2022

Cathet Cardio Intervent

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Background and Objectives Evidence regarding redo percutaneous interventions for recurrent mitral regurgitation is scarce. We ought to evaluate procedural and clinical outcomes of repeated edge‐to‐edge transcatheter mitral valve repair (TMVR) interventions. Methods This multicenter study collected individual data from eight high‐volume TMVR Centers in Spain. Between 2012 and 2020, all patients undergoing a second edge‐to‐edge TMVR intervention (Redo) were included in the study. Results Among a total of 1028 procedures, 31 patients (3%) with residual MR ≥ 3 at follow‐up underwent a second procedure (Redo). Redo intervention was mainly conducted between the first and second year after the first procedure. The most common cause of MR progression was partial detachment (46.7%) followed by LV remodeling (35.5%). Procedural success was achieved in 87% of cases. After a mean follow‐up of 1.75 ± 1.54 years, all‐cause and cardiovascular mortality were 48.1% and 25%, respectively. Nearly half of the patients (48.1%) required at least one hospital admission for CHF within the follow‐up period. However, most of the patients presented symptomatic improvement as depicted by an NYHA class ≤2. Elective mitral surgery was conducted in only one patient at follow‐up due to insufficient MR reduction. Conclusions According to our findings, redo edge‐to‐edge TMVR interventions were feasible and safe with a high procedural success rate. Clinical and echocardiographic follow‐up showed however modest long‐term results in this specific setting.

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Repeated MitraClip procedure in patients with recurrent MR after a successful first procedure: Limitations and outcome

Abstract: A ReClip procedure may be feasible in patients with recurrent MR but the risk benefit ratio should be carefully balanced against other treatment options.

Cited by 9 publications

References 27 publications

Re‐do MitraClip in patients with functional mitral valve regurgitation and advanced heart failure

Re‐do MitraClip in patients with functional mitral valve regurgitation and advanced heart failure

Editorial: Just clip it, then ReClip it again: Expanding populations for transcatheter mitral repair and options for recurrent mitral regurgitation

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

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