Transcatheter edge-to-edge mitral valve repair following surgical annuloplasty with ring implantation. Results from the multicenter “Clip-in-Ring” registry

Abstract

Management of mitral regurgitation (MR) recurrence after failed surgical mitral annuloplasty with ring implantation (SMARI) is controversial. Transcatheter edge-to-edge mitral valve repair (TEER) is one option, but rings increase the procedural’ difficulty. To evaluate the results of TEER in patients with SMARI. The Clip-in-Ring registry is a multicenter registry conducted in 11 centers in France, approved by local institutional review boards, of consecutive TEER following SMARI. Outcomes were the Mitral Valve Academic Research Consortium (MVARC) technical, modified 30-days device and procedural successes (where 10 mmHg is considered as a cut-off for significant mitral stenosis) and MVARC-complications. Twenty three patients were studied: age: 69 ± 10; male: 74%; STS score: 3.0 [2.0–5.8], EuroScore II: 12.0 [6.4–18.5]; left ventricle ejection fraction: 53 ± 12%; complete rings: 60%; MR grade 3+/4+: 17/78%; NYHA class III/IV: 47/22%; median surgery-TEER delay: 23 [6–94] months. Technical success of the TEER was 100%. At discharge, residual MR grade was ≤ 2+ in 87% and median trans-mitral gradient was 4 [3–5] mmHg. Thirty days modified MVARC-device success device and procedural success were 82%: 4 patients (17%) had residual MR grade > 2+, including 2 patients who needed a complementary surgery. No patient had a 30-days trans-mitral gradient > 7 mmHg. No patient died or suffered a stroke or any life-threatening complications. One patient presented vascular access complication requiring transfusion. No other MVARC-2 adverse event was reported (Fig. 1). TEER in patients with failed mitral ring is feasible, and safe. Larger registries should delineate its exact role in the therapeutic armamentarium for this medical issue.