Percutaneous Repair for Recurrent Mitral Regurgitation After Surgical Repair: A Mitraclip Experience

Abstract

ABSTRACTBackground: The aim of our study was to evaluate the acute feasibility and short-term efficacy of mitral valve repair using the MitraClip device in patients with prior surgical repair. Mitral regurgitation (MR) may recur after surgical repair. Because reoperation is associated with significant mortality and morbidity, a transcatheter approach appears appealing.Methods: Between April 2015 and December 2016, 12 patients with MR after a previous surgical repair underwent the MitraClip procedure. Procedural details, intraoperative echocardiographic features, and baseline and 30-day clinical follow-up data were analyzed and compared to those of patients undergoing MitraClip therapy with no prior surgical repair (n = 54) within the same timeframe.Results: Past medical history, MR severity, and NYHA class did not differ between the two groups. A MitraClip was deployed in all 12 patients in the surgical repair (SR) group and in 51 patients in the no surgical repair (NR) group. Induction of mitral stenosis precluding final device deployment occurred in one and two cases, respectively. The procedure was associated with successful reduction of MR to ≤ moderate in all SR patients and in 47 (96%) NR patients. Total procedural time, fluoroscopy time, time from transseptal access to first MitraClip release, and final diastolic gradients were not different between the groups. Clinical outcomes—NYHA class and KCCQ scores—were not different at 30 days.Conclusions: In selected patients with recurrent MR after surgical repair, the MitraClip procedure is feasible and effective without significant increase in procedural time, fluoroscopy time, diastolic mitral gradient compared to MitraClip therapy in patients without prior surgical repair.