Evaluating the Efficacy of Mitral Valve Surgery after Percutaneous Edge-to-Edge Mitral Valve Repair

Background: Percutaneous edge-to-edge mitral valve repair with MitraClip is a less invasive alternative to traditional mitral valve surgery and is increasingly favored for high-risk or “inoperable” patients. However, the long-term efficacy of this procedure remains unverified, and failed interventions reduced repair success and heightened intraoperative risks. This study aims to assess the early and mid-term outcomes of mitral valve surgery following such repairs.

Methods: We conducted a retrospective two-center study, analyzing patients who had received mitral valve repair or replacement after failed MitraClip repair between 2018 and 2023. Primary endpoints were all-cause mortality at 30 days, 90 days, one year, and postoperative morbidity within the hospitalization. Secondary endpoints were defined as freedom from severe mitral regurgitation, improved clinical (New York Heart Association (NYHA) stage), and echocardiographic parameters (left ventricular ejection fraction (LVEF), mitral regurgitation (MR)) at 30 days, 90 days, and one year postoperatively.

Results: In total, 32 patients met the inclusion criteria and underwent further follow-up. The all-cause mortality rates revealed survival rates of 90% at 30 days, 87% at 90 days, and 87% at one-year postintervention. Additionally, there was a significant improvement in the NYHA functional class at all assessed postoperative time points (30 days, 90 days, and one year p < 0.05), coupled with sustained freedom from the NYHA functional class IV during postoperative follow-up. Postoperatively, there was a significant reduction in LVEF from 53% preoperatively to 48% (p < 0.05), yet the LVEF remained stable when comparing the 30-day, 90-day, and one-year postoperative marks (53% vs. 48% vs. 48%, p>0.05). Mitral valve function remained stable, with a complete absence of severe MR observed after both 90 days and one year.

Conclusion: Our study demonstrates that patients defined as inoperable by the time they underwent transcatheter edge-to-edge repair show a survival rate of 90% in the first 30 days and 87% in one year after high-risk mitral valve surgery. Therefore, it is essential to critically reassess and discuss interdisciplinary the definition of “inoperable” to facilitate optimal treatment and patient selection. Our results provide valuable insights into the efficacy of mitral valve surgery following MitraClip repair, highlighting the need for further studies for a better understanding of its long-term benefits and limitations.

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Artikel online veröffentlicht:
13. Februar 2024