Failed MitraClip Research Articles

Mitral Valve Replacement for Failed Mitra Clip: A Case Report

Mitra Clip is an interventional procedure used in mitral regurgitation patients who are surgically inoperable or are at high surgical risk. However, there is a failure rate associated with this procedure and in some instances no surgical intervention can be offered due to the inoperability risk. We report a case of failed Mitra Clip in a patient that was originally considered to be high surgical risk due to frailty that later required a double valve surgery for failed Mitra Clip within 1 year of the procedure. Although her surgical risk was even higher at the time of surgery, the patient tolerated the surgical procedure well with no complication. This case highlights the importance of properly defining patients at high surgical risk at the first instance as subsequent surgery can be performed with excellent outcome.

First-in-Human Percutaneous Excision of a Failed MitraClip Followed by Transcatheter Mitral Valve Replacement

First-in-Human Percutaneous Excision of a Failed MitraClip Followed by Transcatheter Mitral Valve Replacement

Mitral Valve Repair for Failed MitraClip: a Case Report

Mitral Valve Repair for Failed MitraClip: a Case Report

Transcatheter edge-to-edge repair with the PASCAL device for failed MitraClip procedure.

Transcatheter edge-to-edge repair with the PASCAL device for failed MitraClip procedure.

Two Cases of Surgical Correction of Recurrent Mitral Regurgitation due to Failed Catheter- Delivered Mitral Clip (MitraClip).

From April 2018 to February 2021, 150 patients underwent MitraClip implantation for severe functional mitral regurgitation (MR) at our hospital. Two of our patients, an 85-year-old man and an 84-year-old woman, developed a single leaflet device attachment in the acute phase after the implantation and had severe residual MR requiring surgical correction. The recurrent MR was first pointed out on day 5 and day 4, and the duration between MitraClip implantation and surgery was 13 and 55 days, respectively. Due to strong adhesions with the clips and severe valve damage after MitraClip implantation, both cases underwent mitral valve replacement with a good postoperative course. In patients with a high-risk baseline profile, surgical mitral valve replacement after failed MitraClip implantation should be considered at an optimal timing, and a detailed echocardiographic follow-up is required.

Mitral valve surgery after failed MitraClip-Operation for the inoperable?

Percutaneous edge-to-edge mitral valve repair technique (MitraClip) is a widely used treatment for mitral regurgitation (MR) in patients assessed with high surgical risk or inoperability. Only limited experiences with this highest-risk patient population exist. Procedural failure for MitraClip or recurrent MR is a strong predictor of 1-year mortality. Open mitral valve surgery constitutes the last bailout for patients within this cohort. This retrospective single-center cohort study analyzed 17 mitral valve surgery patients after failed MitraClip. We, therefore, analyzed a high-risk patient population (EuroSCOREII = 10 ± 2.0) with persistent mitral valve regurgitation, which was mainly caused by detachment or dislocation of the MitraClip. Symptomatic patients with failed MitraClip need a convenient operation (mean time to mitral valve surgery = 23 ± 44 days). The patient's collective showed many complex reoperations with the need for concomitant surgery. Considering the high-risk patient population, we showed an average 30-day all-cause mortality (18%, n = 3) accompanied by typical postoperative complications related to prolonged mechanical ventilation (44 ± 48 h) and ICU stay (11 ± 11 days), reflecting high-risk patients. Further, excellent valve-related outcomes were shown regarding adverse cardiac events (valve-related mortality 6%, n = 1) and postoperative echocardiographic results (moderate or severe paravalvular leak 6%, n = 1). Failure of MitraClip represents a challenging situation limited by high-risk profiles of patients and limits the possibility of surgical valve repair, shown by a high rate of mitral valve replacement (94%, n = 16). Secondary surgery was associated with moderate 30-day and postdischarge outcomes. Therefore, a careful evaluation of patients undergoing MitraClip is of paramount importance.

Transcatheter Electrosurgical Laceration and Stabilization of Failed MitraClip[s]/SAPIEN M3 for Treatment of Failed MitraClip.

HomeCirculation: Cardiovascular InterventionsVol. 15, No. 5Transcatheter Electrosurgical Laceration and Stabilization of Failed MitraClip[s]/SAPIEN M3 for Treatment of Failed MitraClip No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessCase ReportRequest AccessFull TextTranscatheter Electrosurgical Laceration and Stabilization of Failed MitraClip[s]/SAPIEN M3 for Treatment of Failed MitraClip Errol K. Inci, Adam B. Greenbaum, Robert J. Lederman, Keshav Kohli, John C. Lisko, Isida Byku, Patrick T. Gleason, Joe X. Xie, Nikoloz Shekiladze and Vasilis C. Babaliaros Errol K. InciErrol K. Inci https://orcid.org/0000-0002-4449-444X Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.). Search for more papers by this author , Adam B. GreenbaumAdam B. Greenbaum https://orcid.org/0000-0001-7496-5954 Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.). Search for more papers by this author , Robert J. LedermanRobert J. Lederman https://orcid.org/0000-0003-1202-6673 Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.J.L.). Search for more papers by this author , Keshav KohliKeshav Kohli https://orcid.org/0000-0002-1469-4088 Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, Atlanta (K.K.). Search for more papers by this author , John C. LiskoJohn C. Lisko Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.). Search for more papers by this author , Isida BykuIsida Byku Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.). Search for more papers by this author , Patrick T. GleasonPatrick T. Gleason https://orcid.org/0000-0001-5739-9030 Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.). Search for more papers by this author , Joe X. XieJoe X. Xie Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.). Search for more papers by this author , Nikoloz ShekiladzeNikoloz Shekiladze Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.). Search for more papers by this author and Vasilis C. BabaliarosVasilis C. Babaliaros Correspondence to: Vasilis Babaliaros, MD, Emory Structural Heart and Valve Center, 550 Peachtree St NE, 4th Floor Davis-Fischer Bldg, Atlanta, GA 30308. Email E-mail Address: [email protected] https://orcid.org/0000-0002-9438-0846 Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.). Search for more papers by this author Originally published17 May 2022https://doi.org/10.1161/CIRCINTERVENTIONS.122.012014Circulation: Cardiovascular Interventions. 2022;15FootnotesFor Sources of Funding and Disclosures, see page 457.Correspondence to: Vasilis Babaliaros, MD, Emory Structural Heart and Valve Center, 550 Peachtree St NE, 4th Floor Davis-Fischer Bldg, Atlanta, GA 30308. Email [email protected]edu

Clinical Outcomes after Mitral Valve Surgery in Failed MitraClip Procedures.

We retrospectively evaluated in-hospital and overall outcome of patients who received mitral valve replacement (MVR) after failed MitraClip procedure. A total of 26 out of 740 patients received MVR after treatment with MitraClip between June 2010 and December 2020. We analyzed in-hospital mortality and overall mortality during the median follow-up period of 72 days after MVR. The median age in the entire cohort was 77.5 years. In-hospital mortality was 15.4% (n = 4) and the overall mortality during the follow-up period was 27% (n = 7). The median time between the MitraClip procedure and surgery was 34.5 days. The main reasons for surgery were mitral stenosis (23.1%), persistent prolapse of the mitral valve leaflets (42.3%), and persistent tethering of the mitral valve leaflets (34.6%). At the time of surgery all of the patients presented with New York Heart Association 3 and above. The underlying mitral valve pathology was mainly secondary 61.5% (n = 16). Median left ventricular end-diastolic diameter was 60 mm. Preoperative ejection fraction was 40% and above in 73% of the cohort. In addition to the mitral valve procedure, 57.7% of patients received either concomitant tricuspid annuloplasty, aortic valve surgery, ascending aortic replacement, or coronary artery bypass grafting. The need for MVR for failed MitraClip repair is low and the results are acceptable. However, remaining options for reconstruction are usually limited and MVR is often needed. Anticipating success or failure according to the underlying pathology more than according to concomitant risk factors should form the basis in decision making for the treatment modality of first choice.

Mitral Valve Surgery After Failed MitraClip: A Single-Center Experience.

To evaluate candidacy for surgical mitral valve (MV) repair of recurrent mitral regurgitation (MR) after failed MitraClip. Percutaneous mitral repair with MitraClip is safe and effective in patients with degenerative and functional MR with high surgical risk. However, some patients require subsequent mitral surgery for recurrence of significant MR. This single-center, observational study includes consecutive patients who underwent mitral surgery after failed MitraClip. Twenty-five patients (age, 69 ± 15 years; 52% women) with severe symptomatic MR after failed MitraClip implantation underwent mitral surgery after a median interval of 5.1 months (interquartile range, 2.5-14 months). Ten patients underwent MV repair (8 with robotic minithoracotomy) and 15 underwent MV replacement (most with sternotomy). Two patients in whom MV repair was intended underwent MV replacement because MitraClip-related leaflet damage prohibited repair. Examples of relative contraindication for MV repair that led to pursuing MV replacement were advanced patient age in 4 patients (mean age, 85 ± 7.6 years), endocarditis in 1 patient, and severely calcified or rheumatic leaflets in 5 patients. Perioperative complications were rare and intermediate-term mortality was similar between groups (3 patients in the MV repair group [30%] vs 4 patients in the MV replacement group [27%]; P=.90). When performed by an experienced mitral surgeon and within 1 year of failed MitraClip implantation, surgical MV repair is feasible in most patients who were surgical repair candidates before the clip. Having the option for surgical MV repair after failed MitraClip is important to preserve optimal long-term outcomes for patients who undergo transcatheter mitral repair with MitraClip, especially as ongoing trials are shifting to study lower-risk patients who are also candidates for surgical repair.

Mitral valve surgery after a failed MitraClip procedure.

Among patients undergoing transcatheter mitral valve repair with the MitraClip device, a relevant proportion (2-6%) requires open mitral valve surgery within 1 year after unsuccessful clip implantation. The goal of this review is to pool data from different reports to provide a comprehensive overview of mitral valve surgery outcomes after the MitraClip procedure and estimate in-hospital and follow-up mortality. All published clinical studies reporting on surgical intervention for a failed MitraClip procedure were evaluated for inclusion in this meta-analysis. The primary study outcome was in-hospital mortality. Secondary outcomes were in-hospital adverse events and follow-up mortality. Pooled estimate rates and 95% confidence intervals (CIs) of study outcomes were calculated using a DerSimionian-Laird binary random-effects model. To assess heterogeneity across studies, we used the Cochrane Q statistic to compute I2 values. Overall, 20 reports were included, comprising 172 patients. Mean age was 70.5 years (95% CI 67.2-73.7 years). The underlying mitral valve disease was functional mitral regurgitation in 50% and degenerative mitral regurgitation in 49% of cases. The indication for surgery was persistent or recurrent mitral regurgitation (grade >2) in 93% of patients, whereas 6% of patients presented with mitral stenosis. At the time of the operation, 80% of patients presented in New York Heart Association functional class III-IV. Despite favourable intraoperative results, in-hospital mortality was 15%. The rate of periprocedural cerebrovascular accidents was 6%. At a mean follow-up of 12 months, all-cause death was 26.5%. Mitral valve replacement was most commonly required because the possibility of valve repair was jeopardized, likely due to severe valve injury after clip implantation. Surgical intervention after failed transcatheter mitral valve intervention is burdened by high in-hospital and 1-year mortality, which reflects reflecting the high-risk baseline profile of the patients. Mitral valve replacement is usually required due to leaflet injury.

Outcome of medical therapy, repeat intervention, and mitral valve surgery after failed MitraClip therapy.

Optimal treatment for residual mitral regurgitation (MR) after MitraClip failure is not clearly defined. We report our clinical experience and discuss treatment options. Between January 2013 and January 2018, 37 patients (75 ± 8.9years, 46% male) were admitted for symptomatic MR (grade 3.1 ± 0.47) diagnosed after previous MitraClip therapy. Clinical outcome of these patients, who underwent medical therapy alone (n = 8, M-group), repeat MitraClip therapy (n = 8, reMC group), or mitral valve surgery (n = 21, S-group) for residual MR, were retrospectively analyzed. Thirty-day survival was 88% (M-group), 100% (reMC-group), and 76% (S-group). The rate of discharge to home was 88% in the reMC-group, better than 38% in the M-group (p = 0.051) and 19% in the S-group (p < 0.001). Perioperative non-survivors in the S-group had high surgical risk with median logistic EuroSCORE of 64.6% (interquartile range 57.4%-87.0%); all died from low cardiac output syndrome or multiple organ failure. The main MR pathologies resulted from leaflet tear and tethering in the M-group, tethering in the reMC-group, and degenerative valve and leaflet tear in the S-group. Kaplan-Meier analysis of overall survival at 1year showed better outcome for patients in the reMC-group (50%, 95% CI 15.2-77.5%) and S-group (47.6%, 95% CI 25.7-66.7%), as compared to those in the M-group (12.5%, 95% CI 0.70-42.3%) (log-rank test p = 0.108 and p = 0.167, respectively). Medical therapy alone after failed MitraClip therapy resulted in poor 1-year prognosis. In patients without extremely high surgical risk, repeat MitraClip therapy, or surgical revision MIGHT BE CONSIDERED depending on valve pathology and cardiac comorbidities.

Failed MitraClip therapy: surgical revision in high-risk patients

BackgroundMitraClip implantation is a valid interventional option that offers acceptable short-term results. Surgery after failed MitraClip procedures remains challenging in high-risk patients. The data on these cases are limited by the small sample numbers.AimThe aim of our study is to show, that mitral valve surgery could be possible and more advantageous, even in high-risk patients.MethodsBetween 2010 and 2016, nine patients underwent mitral valve surgery after failed MitraClip therapy at our institution.ResultsThe patients’ ages ranged from 19 to 75 years (mean: 61.2 ± 19.6 years). The median interval between the MitraClip intervention and surgical revision was 45 days (range: 0 to 1087 days). In eight of nine patients, the MitraClip intervention was initially successful and the mitral regurgitation was reduced. Only one patient had undergone cardiac surgery previously.Intra-operatively, leaflet perforation or rupture, MitraClip detachment, and chordal or papillary muscle rupture were potentially the causes of recurrent mitral regurgitation.There were three early deaths. One year after surgery, the six remaining patients were alive.ConclusionsMitral valve surgery can be successfully performed after failed MitraClip therapy in high-risk patients. The initial indication for MitraClip therapy should be considered carefully for possible surgical repair.

Surgical revision of failed percutaneous edge-to-edge mitral valve repair: lessons learned

Although percutaneous edge-to-edge mitral valve repair with the MitraClip system is becoming widely adopted in clinical practice, surgical experience on how to correct failed MitraClip therapy is limited. We aimed to analyse the surgical and pathological outcomes after surgical revision of the failed MitraClip therapy. Between January 2011 and January 2018, 25 patients (age 73 ± 9 years; men 48%; New York Heart Association class 3.4 ± 0.49) were admitted for severe mitral regurgitation at a median of 54 days (range 1-1496 days) after MitraClip edge-to-edge repair. Perioperative variables were analysed for their association with surgical outcomes. All patients underwent explantation of the MitraClip system and subsequent mitral valve replacement. Perioperative mortality was as high as 28%, mainly due to pre-existing cardiogenic or septic shock. The Kaplan-Meier analysis revealed a 53% overall 1-year survival. Among preoperative variables, the logistic European System for Cardiac Operative Risk Evaluation score, left ventricular ejection fraction and liver dysfunction had a significant influence on in-hospital survival. Intraoperatively, the predominant pathology included mitral valve leaflet damage due to tear, degeneration or infection. Although leaflet tears or MitraClip detachment mainly occurred within the first 6 months after MitraClip therapy, leaflet infections and degeneration mainly occurred later during follow-up. The surgical revision of failed MitraClip therapy is feasible but has high perioperative mortality, especially among patients with cardiogenic shock, septic shock or liver failure. Mitral regurgitation after the MitraClip therapy is mainly caused by mitral valve leaflet damage due to tear, degeneration or infection, all related to the MitraClip itself.

RF51 MITRAL VALVE REPLACEMENT AFTER FAILED MITRACLIP

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 &lt; 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.

Is Surgical or Catheter-based Interventions an Option After an Unsuccessful Mitral Clip?

The objective of this study was to assess the results of catheter-based and surgical reinterventions in primary mitral regurgitation after failed MitraClip therapy. We report on 21 consecutive symptomatic patients with primary mitral regurgitation (median age 78 years) who underwent either repeat MitraClip therapy (n = 7) or mitral valve surgery (n = 14) after failure of the index procedure with 1-2 MitraClip implantations. At the time of reinterventions, 193 (interquartile range [IQR]: 32-622) days after the index procedure, patients had recurrent or persistent grade 3 mitral regurgitation. Early mortality at 30 days was 4.8%. Cardiac-related survival at 2 years was 85.4% (4 cardiac and 4 noncardiac deaths). Three of 7 patients with percutaneous reintervention were converted to surgery at 34, 52, and 56 days because repeat MitraClip therapy was ineffective because of pre-existing clip detachment or leaflet tear. Final therapy was biological mitral valve replacement in 14 of 21 patients (66.7%); 4 were treated with percutaneous repeat MitraClip repair (19%), and in 3 patients, surgical repairs were performed (14.3%). At follow-up with a median of 708 days, New York Heart Association class had improved significantly to class 2 (IQR: 1.0-2.5) (P = 0.0004), and the left ventricular end-diastolic diameter had decreased from 56 (IQR: 52-59) mm to 51 (48-58) mm (P = 0.0378), respectively. Recurrence of significant mitral regurgitation was absent in all but 1 patient with unsuccessful repeat MitraClip therapy who was deemed inoperable. Our data show that both repeat MitraClip and also mitral valve surgery are feasible and safe alternatives in patients without an excessively increased perioperative risk. We conclude that whenever leaflet insertion is not compromised, repeat catheter-based repair is a reasonable redo concept; in the remaining cases, surgery should be offered to the patient.

Surgical mitral valve intervention following a failed MitraClip procedure.

The MitraClip procedure has shown promising results in patients with high surgical risk. However, data concerning outcomes of open mitral valve surgery for failed MitraClip procedures are sparse. In a retrospective clinical investigation, baseline characteristics, intraoperative and histopathological findings, surgical indications and results of patients who required surgery after a failed MitraClip procedure were collected. Between March 2010 and May 2016, 25 patients presented at our department with severe mitral valve regurgitation following a failed MitraClip procedure. Leaflet destruction or severe adhesions between leaflets and the implanted clip were the commonest intraoperative findings. Upon surgery, the mitral valve was either repaired (n=5, 20%) or replaced (n=20, 80%) with a biological prosthesis. Four patients who had presented in cardiogenic shock prior to the operation died within the first 30 days. In the majority of cases, mitral valve replacement is preferred over repair due to severe leaflet damage following the MitraClip procedure. Only those patients who present in cardiogenic shock are at extremely high risk for in-hospital mortality.

Invited Commentary

Invited Commentary

Survival Prediction in Patients Undergoing Open-Heart Mitral Valve Operation After Previous Failed MitraClip Procedures

The objective of this study was to analyze the results of open heart mitral valve operations for survival prediction in patients with previously unsuccessful MitraClip procedures. Thirty-three consecutive patients who underwent mitral valve surgery in our institution were studied. At a median of 41 days, they had previously undergone one to five futile MitraClip implantations. At the time of their operations, patients were 72.6 ± 10.3 years old, and the calculated risk, using the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II, was a median of 26.5%. Individual outcomes were recorded, and all patients were monitored postoperatively. Thirty-day mortality was 9.1%, and the overall survival at 2.2 years was 60.6%. Seven cardiac-related and six noncardiac deaths occurred. Univariate survival regression models demonstrated a significant influence of the following variables on survival: EuroSCORE II (p = 0.0022), preoperative left ventricular end-diastolic dimension (p = 0.0052), left ventricular ejection fraction (p = 0.0249), coronary artery disease (p = 0.0385), and severe pulmonary hypertension (p = 0.0431). Survivors showed considerable improvements in their New York Heart Association class (p < 0.0001), left ventricular ejection fraction (p = 0.0080), grade of mitral regurgitation (p = 0.0350), and mitral valve area (p = 0.0486). Survival after mitral repair was not superior to survival after replacement. Indications for surgery after failed MitraClip procedures must be considered with the greatest of care. Variables predicting postoperative survival should be taken into account regarding the difficult decision as to whether to operate or not. Our data suggest that replacement of the pretreated mitral valve is probably the more reasonable concept rather than complex repairs. When the EuroSCORE II at the time of surgery exceeds 30%, conservative therapy is advisable.

Mitral valve surgery in 6 patients after failed MitraClip therapy.

The MitraClip percutaneous mitral valve repair system, developed as an option for percutaneous mitral repair, was clinically introduced in 2007. From 2010 through 2012, 6 of our patients underwent mitral valve surgery after MitraClip failure. Their mean age was 75 ± 7.7 years (range, 62-87 yr). Three had undergone cardiac surgery previously. In 5 of the 6 patients, mitral regurgitation recurred after initially successful MitraClip deployment and was the indication for surgery. The mean interval between MitraClip implantation and surgery was 106 ± 86 days (range, 0-238 d). Mitral valve repair was feasible in 3 patients; the others underwent valve replacement. All the patients underwent additional cardiac procedures, because the MitraClip worsened existing conditions. Echocardiograms revealed sufficient valvular repairs. Two patients died during hospitalization, one of cerebral infarction and the other of bowel ischemia. Mitral valve repair after failed MitraClip therapy can be complex and a surgical challenge. Careful consideration should be given to appropriate patient selection for MitraClip therapy, because the MitraClip can cause existing pathologic valvular conditions to deteriorate substantially. The interval between MitraClip failure and corrective surgery should be as short as possible. The primary indication is an issue of ongoing discussion.

TCT-89 Percutaneous Leaflet Therapy of Severe Primary Mitral Regurgitation: Totality of Evidence From the EVEREST II Randomized, Continued Access, and High Risk Clinical Programs

a degenerative MR patient after 3.2 years. There were no strokes with an average follow-up of 2.4 1.8 years. There were sustained improvements in New York Heart Association class (from 2.8 0.6 to 1.6 0.5, p <0.001) and MR grade (from 3.5 0.9 to 0.4 0.5, p <0.001) at follow-up. Conclusions: In this large single center experience, no patient required urgent cardiac surgery for failed MitraClip procedure. Mitral valve repair rate in patients with degenerative MR was high, and surgical options were preserved in the remaining patients. Overall, cardiac surgical outcomes were excellent.