Clinical Outcomes after Mitral Valve Surgery in Failed MitraClip Procedures

Abstract

Background We retrospectively evaluated in-hospital and overall outcome of patients who received mitral valve replacement (MVR) after failed MitraClip procedure.

Methods A total of 26 out of 740 patients received MVR after treatment with MitraClip between June 2010 and December 2020. We analyzed in-hospital mortality and overall mortality during the median follow-up period of 72 days after MVR.

Results The median age in the entire cohort was 77.5 years. In-hospital mortality was 15.4% (n = 4) and the overall mortality during the follow-up period was 27% (n = 7). The median time between the MitraClip procedure and surgery was 34.5 days. The main reasons for surgery were mitral stenosis (23.1%), persistent prolapse of the mitral valve leaflets (42.3%), and persistent tethering of the mitral valve leaflets (34.6%). At the time of surgery all of the patients presented with New York Heart Association 3 and above. The underlying mitral valve pathology was mainly secondary 61.5% (n = 16). Median left ventricular end-diastolic diameter was 60 mm. Preoperative ejection fraction was 40% and above in 73% of the cohort. In addition to the mitral valve procedure, 57.7% of patients received either concomitant tricuspid annuloplasty, aortic valve surgery, ascending aortic replacement, or coronary artery bypass grafting.

Conclusion The need for MVR for failed MitraClip repair is low and the results are acceptable. However, remaining options for reconstruction are usually limited and MVR is often needed. Anticipating success or failure according to the underlying pathology more than according to concomitant risk factors should form the basis in decision making for the treatment modality of first choice.

Keywords

MitraClip - functional mitral regurgitation - mitral valve surgery

Authors' Contributions

C.P.: Substantial contributions to the conception and design of the work, acquisition, analysis, and interpretation of data for the work. Drafting the work and revising it critically for important intellectual content, final approval of the version to be published.

M.K.: Substantial contributions to the conception of the work and revising it critically for important intellectual content, final approval of the version to be published.

T.M.: Substantial contributions to the conception of the work and revising it critically for important intellectual content. Final approval of the version to be published.

M.T.: Substantial contributions to the acquisition, analysis, and interpretation of data for the work, revising the work critically for important intellectual content, final approval of the version to be published.

F.B.: Substantial contributions to the acquisition, analysis, and interpretation of data for the work. Revising it critically for important intellectual content and final approval of the version to be published.

T.C.: Substantial contributions to the conception of the work and revising it critically for important intellectual content. Final approval of the version to be published.

A.F.: Substantial contributions to the conception of the work and revising it critically for important intellectual content, final approval of the version to be published.

M.S.: Substantial contributions to the conception of the work and revising it critically for important intellectual content. Final approval of the version to be published.

M.C.: Substantial contributions to the conception and design of the work, acquisition, analysis, and interpretation of data for the work, drafting the work, and revising it critically for important intellectual content, final approval of the version to be published.

All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Publication History

Received: 22 August 2021

Accepted: 03 January 2022

Article published online:
25 February 2022

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