RF51 MITRAL VALVE REPLACEMENT AFTER FAILED MITRACLIP

Abstract

Aim: The aim of this study was to evaluate the immediate and follow-up results of mitral valve replacement on patients previously treated with unsuccessful MitraClip procedures. Methods: Between February 2012 and April 2018, fifteen consecutive patients (75 ± 8.2 years) underwent mitral valve replacement in our institution after failed percutaneous edge-to-edge mitral valve repair. The reasons of failure were acute leaflet rupture in three cases (20%), massive leaflets fibrosis causing severe stenosis in five patients (33%) and clips dislocation causing severe regurgitation in seven patients (47%). The calculated operative risk, using the EuroSCORE II, was 16 ± 11.8%. Nine patients (60%) were in NYHA Class III or IV and four patients (26%) were in a critical pre-operative state. Results: At 30 days, one patient died (6.7%). Nine patients (60%) required IABP for weaning from CPB. The length of hospital stay was a median of 10 days. The survived patients experienced a consistent reduction in pulmonary hypertension (pre-op 59 ± 14.3 vs post-op 46 ± 13.1 p < 0.0001). At 3-years follow-up, the overall survival was 56.3 ± 16.51. Seventy-five percent of patients were in NYHA class I/II. Conclusion: In our experience, high risk patients requiring mitral valve surgery after unsuccessful Mitraclip procedure may be operated with acceptable 30-days mortality and morbidity. In this light, this option should be always discussed after a failed Mitraclip, even in critical situation.