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DOI: 10.1055/s-0031-1297619
Cardiac surgery after failed MitraClip intervention
Objective: Percutaneous mitral valve (MV) intervention with the MitraClip device (Abbott Lab., Illinois, USA) has been recently used in an increasing number of patients. However, surgical options after failed clipping are crucial and the effects on surgery and prognosis are unknown.
Methods: Eleven patients (age: 72±9 years) with severe mitral regurgitation (MR) and treatment failure after implantation of 1.5±0.7 (range: 1–3) MitraClips underwent surgery 0–193 days (median 20) later. Clinical and echocardiographic data before mitral clipping and surgery were compared as well as the surgical outcome was analysed in detail.
Results: Between clip-implantation and surgery the LogEuroScore had increased significantly from 31±20% to 51±25% (p=0.002, Wilcoxon signed-rank test). Mitral valve surgery was finally reconstructive in 8 of 11 patients (73%), but in all cases associated procedures had to be performed (eg tricuspidal valve repair, atrial fibrillation ablation surgery or coronary artery bypass grafting). Moreover all patients had an artificial atrial septum defect caused by the clipping procedure that was closed surgically. There was one early cardiac death. Though residual MR after surgery was grade 0–1 (0.4±0.5), survival at 6 weeks and 6 months follow-up was only 82% and 73%, respectively (total deaths: n=3).
Conclusion: Because of severely aggravated cardiac pathology in parallel with reduced preoperative state after failed MitraClip intervention, surgery in that situation is really complex and requires the full spectrum of valvular repair techniques. However, we experienced that the perspectives of an optimal surgical solution with highest clinical benefit of MV surgery is reduced by the failed prior clipping procedure.