Surgical Mitral Valve Repair and Replacement after Percutaneous Edge-to-Edge Mitral Valve Repair

Objectives: The purpose of this study is to provide mid-term results following mitral valve surgery in patients in whom transcatheter mitral valve edge-to-edge repair (TMVr) was attempted as an initial treatment strategy because of elevated surgical risk as assessed by the Heart Team.

Methods: Consecutive patients with previous successful or attempted TMVr, who underwent mitral valve surgery in this institution, were analyzed. Thirty-day, three-month and mid-term post-operative mortality were determined.

Result: Among 485 TMVr procedures performed between 2011 and 2020 at Bern University Hospital, a total of 23 patients (4.7%), who were referred for surgery, were included in this analysis.

Baseline patient characteristics/mean (range).

Time since previously attempted edge-to-edge repair: 187 (0–897) days.

Patient's age at percutaneous intervention: 78.8 (51.2–85.6) years.

Patient's age at surgery: 79.4 (51.3–86.0) years.

EuroSCORE II at surgical reoperation: 12.69 (1.16–84.64)%.

During the initial percutaneous intervention, 5 patients received 1 clip and 13 patients had multiple implants. In five patients, TMVr was aborted without clip implantation due to either inability to grasp the leaflets or elevated gradient.

During subsequent surgery, mitral valve replacement was performed with biologic (17 patients) or mechanical (5 patients) prostheses, while surgical mitral valve repair was performed for 1 patient.

Twenty-two patients survived 30 days (96%); 20 patients, the first 3 months (87%). Fourteen patients (60%) were still alive at the end of the observation period (June 30, 2020); mean follow-up was 662 (range: 88–1,302) days.

Conclusion: Elective and emergency mitral valve replacement after attempted TMVr allows excellent results in selected patients deemed at nonprohibitive risk, despite the fact that these patients were initially considered not suitable for surgery.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021