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DOI: 10.1055/s-0030-1269374
Three cases of mechanism-specific complex surgical valve repair after failed percutaneous mitral intervention with the MitraClip® device
Introduction: Catheter-based techniques of percutaneous valve intervention are recently performed in an increasing number of patients. We report our early experience with three cases of finally successful, but complex surgical mitral valve (MV) repair after failed percutaneous intervention with the MitraClip® device (Abbott Lab., Illinois, USA).
Aims: Three patients (age: 66±11 years; logistic euroSCORE: 36±27%, one degenerative and two chronic ischemic MV cases) underwent surgical repair 10, 32 and 85 days after failed mitral clipping. The repair included clip-explantation, chordal replacement, leaflet repair and annuloplasty using a 2-dimensional or a 3-dimensional shaped ring-device. Patients were restudied 1 week and 3 months after surgery to assess survival, New York Heart Association (NYHA) class, residual MR, left ventricular ejection fraction (LVEF), leaflet coaptation height (LCH) and mitral orifice area (MOA). Survival at time of reexamination was 100%. NYHA-class improved from 3.6±0.4 to 2.0±1.0, LVEF increased from 35±13% to 40±18%. Residual MR after surgery was grade 0.7±0.6, postoperative recurrence of significant MR was absent in all patients. Further, enduring LCH (8±1mm) and adequate MOA (3.2±0.5cm2) could be documented.
Discussion: Although surgical MV repair after leaflet-clipping represents a challenge, it can be successfully done by an experienced team even in complex situations. However, we found a severely aggravated mitral pathology caused by the catheter-based procedure. There is a substantial risk to reduce the benefit of conventional MV surgery by a first-step-clipping. Therefore indications should be discussed carefully since the likelihood of a perfect surgical MV repair predicts the patients prognosis that is possibly impaired afterwards.