Interventions for valvular disease and heart failure

Clinical impact of intervention strategies after failed transcatheter mitral valve repair

EuroIntervention 2021;16:1447-1454. DOI: 10.4244/EIJ-D-20-01008

Hannes Alessandrini
Hannes Alessandrini1, MD; Ansgar Dreher1, MD; Claudia Harr1, MD; Peter Wohlmuth2, PhD; Felix Meincke1, MD; Samer Hakmi1, MD; Timm Ubben1, MD; Karl-Heinz Kuck3, MD; Kambiz Hassan4, MD; Stephan Willems1, MD; Michael Schmoeckel4, MD; Stephan Geidel4, MD
1. Department of Cardiology, Asklepios Klinik Sankt. Georg, Hamburg, Germany; 2. Proresearch Institute, Asklepios Klinik Sankt. Georg, Hamburg, Germany; 3. LANS Medicum, Hamburg, Germany; 4. Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany

Aims: 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 was to evaluate the survival outcome following percutaneous procedures and surgery after unsuccessful TMVR interventions for different aetiologies.

Methods and results: Of 824 consecutive patients who 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 versus 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 with PMR showed lower mortality than patients with SMR (p<0.0001) and ReClip patients with PMR (p=0.073). Atrial fibrillation (HR 2.915, 95% CI: [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 MR had no relevant impact on survival.

Conclusions: We conclude that, after SMR and failed TMVR, reclipping is an appropriate treatment option for symptomatic patients. For PMR patients, surgery must be favoured over a reclipping 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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mitral regurgitationmitral valve diseasemitral valve repairPrior percutaneous intervention
Interventions for valvular diseaseMitral valve replacement and repair
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