The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Clinical Impact of Intervention Strategies after failed Transcatheter Mitral Valve Repair

DOI: 10.4244/EIJ-D-20-01008

1. Department of Cardiology, Asklepios Klinik Sankt Georg, Germany
2. Proresearch Institute, Asklepios Klinik Sankt Georg, Germany
3. Department of Cardiac Surgery, Asklepios Klinik Sankt Georg, Germany
4. LANS Medicum Hamburg, Germany
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Objective: Failure of Transcatheter Mitral Valve Repair (fTMVR) therapy has a decisive prognostic influence, and complex retreatment is of higher risk. The aim of this analysis is to evaluate the survival outcome of percutaneous procedures and surgery after unsuccessful TMVR interventions for different etiologies.

Methods and Results: Of 824 consecutive patients that had been treated with the MitraClip device at our institution, between September 2009 and May 2019, 63 (7.6%) symptomatic patients with therapy failure and persistent or recurrent mitral regurgitation (MR) underwent reinterventions. An outcome analysis for primary (PMR) and secondary mitral regurgitation (SMR) and subsequent percutaneous vs. surgical treatment was carried out. MitraClip reinterventions were performed in 36 patients (57.1%; n=26 SMR, n=10 PMR), while 27 (42.9%; n=13 SMR, n=14 PMR) underwent open-heart surgery. Surgical patients wiith PMR showed lower mortality than patients with SMR (p < 0.0001) and reclip patients with PMR (p = 0.073). Atrial fibrillation (HR & 95 CI: 2.915 [1.311, 6.480]), prior open-heart surgery (2.820 [1.215, 6.544] and chronic obstructive pulmonary disease (2.506 [1.099, 5.714]) increased the risk of death. The level of post-interventional mitral regurgitation had no relevant impact on survival.

Conclusion: We conclude that after SMR and failed TMVR, reclipping is an appropriate treatment option for symptomatic patients. For PMR patients, surgery must be favored over a ReClip procedure. However, patients with atrial fibrillation, prior open-heart surgery and chronic obstructive pulmonary disease are at risk of reduced survival after reinterventions.

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