Mitral Valve Surgery in Patients Following MitraClip® Therapy

Background and aim of the study: Treatment of mitral regurgitation with MitraClip® implantation is usually indicated for patients deemed high risk or inoperable. However, in several cases these patients require surgical intervention after MitraClip implantation. Herein is reported the authors’ experience of mitral valve surgery in patients who had undergone prior MitraClip implantation.

Methods: Twenty consecutive patients (median age 75 years; 25th-75th percentile 65-79 years) were identified after MitraClip implantation, and who underwent mitral valve surgery between March 2014 and July 2018. The outcomes of the patients were analyzed.

Results: The median EuroSCORE II at the time of surgical revision was 25.1% (10.4-44.7%), whereas the median Society of Thoracic Surgeons Predicted Risk of Mortality was 13.2% (7.1-20.2%). The median time to surgical revision was 130 days (8-366 days), with 25.0%

of the patients requiring surgical intervention within 24 h. The median number of MitraClips implanted was two (1-3), with 75.0% (n = 15) of patients being treated with multiple MitraClips. Indications for surgery in the MitraClip group were insufficient coaptation (n = 9), flail of the posterior mitral leaflet (PML) (n = 5), persistent atrial septal defect with left-to-right shunt (n = 3), rupture of anterior mitral leaflet (AML) (n = 2), rupture of AML and PML (n = 1), and endocarditis (n = 2). The median length of hospital stay was 22 days (14-51 days), with a median intensive care unit stay of 11 days (6-37 days). The 30-day mortality was 10.0%.

Conclusion: Surgical intervention after a MitraClip procedure may be required in case of early or late failure or infection. Redo-mitral valve surgery, even in high-risk patients, is feasible and associated with acceptable mortality rates.

The Journal of Heart Valve Disease 2018-19;28:53-58