Mitraclip after failed surgical mitral valve repair—an international multicenter study

Zouhair Rahhab, David Scott Lim, Stephen H. Little, Maurizio Taramasso, Shingo Kuwata, Matteo Saccocci, Corrado Tamburino, Carmelo Grasso, Christian Frerker, Theresa Wißt, Ross Garberich, Jörg Hausleiter, Daniel Braun, Eleonora Avenatti, Victoria Delgado, Gian Paolo Ussia, Fausto Castriota, Roberto Nerla, Hüseyin Ince, Alper ÖnerRodrigo Estevez-Loureiro, Azeem Latib, Damiano Regazzoli, Nicolo Piazza, Hind Alosaimi, Peter P.T. de Jaegere, Jeroen Bax, Danny Dvir, Francesco Maisano, Paul Sorajja, Michael J. Reardon, Nicolas M. Van Mieghem

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Recurrence of mitral regurgitation (MR) after surgical mitral valve repair (SMVR) varies and may require reoperation. Redo mitral valve surgery can be technically challenging and is associated with increased risk of mortality and morbidity. We aimed to assess the feasibility and safety of MitraClip as a treatment strategy after failed SMVR and identify procedure modifications to overcome technical challenges. METHODS AND RESULTS: This international multicenter observational retrospective study collected information for all patients from 16 high-volume hospitals who were treated with MitraClip after failed SMVR from October 29, 2009, until August 1, 2017. Data were anonymously collected. Technical and device success were recorded per modified Mitral Valve Academic Research Consortium criteria. Overall, 104 consecutive patients were included. Median Society of Thoracic Surgeons score was 4.5% and median age was 73 years. At baseline, the majority of patients (82%) were in New York Heart Association class ≥III and MR was moderate or higher in 86% of patients. The cause of MR pre-SMVR was degenerative in 50%, functional in 35%, mixed in 8%, and missing/unknown in 8% of patients. The median time between SMVR and MitraClip was 5.3 (1.9–9.7) years. Technical and device success were 90% and 89%, respectively. Additional/modified imaging was applied in 21% of cases. An MR reduction of ≥1 grade was achieved in 94% of patients and residual MR was moderate or less in 90% of patients. In-hospital all-cause mortality was 2%, and 86% of patients were in New York Heart Association class ≤II. CONCLUSIONS: MitraClip is a safe and less invasive treatment option for patients with recurrent MR after failed SMVR. Additional/ modified imaging may help overcome technical challenges during leaflet grasping.

Original languageEnglish (US)
Article numbere019236
JournalJournal of the American Heart Association
Volume10
Issue number7
DOIs
StatePublished - 2021
Externally publishedYes

Keywords

  • MitraClip
  • Recurrent mitral regurgitation
  • Surgical mitral valve repair

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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