Failure of acute procedural success predicts adverse outcome after percutaneous edge-to-edge mitral valve repair with MitraClip

Abstract

The failure of acute procedural success proved to have the most important impact on outcome after MitraClip implantation.

Risk and outcomes of complications during and after MitraClip implantation: Experience in 828 patients from the German TRAnscatheter mitral valve interventions (TRAMI) registry

“…This may suggest that clinically less stable patients may be particularly prone to procedural complications. Similarly, Puls et al [22] found that patients with worse clinical baseline conditions were at higher risk of procedural failure after MitraClip therapy. Similar to the data by Puls et al [22], mortality was significantly increased among patients with complications as compared to patients without any complications (8.5% vs. 0%).…”

“…Similarly, Puls et al [22] found that patients with worse clinical baseline conditions were at higher risk of procedural failure after MitraClip therapy. Similar to the data by Puls et al [22], mortality was significantly increased among patients with complications as compared to patients without any complications (8.5% vs. 0%). Careful patient selection and timing of the procedure (i.e., postponing the procedure until full recompensation) may thus have the potential to lower complication rates and improve outcomes.…”

“…As in previous studies, clip embolization was not observed in the present registry. In fact, only a single case of clip embolization has been reported worldwide, so far [1,[3][4][5]8,[16][17][18][19][20][21][22][23][24][25][26][27][28][29] (Table V). Partial clip detachment from one leaflet was rarely observed (2% in the present analysis) and occurred spontaneously or during advancement of a second clip for residual MR.…”

Comparison of Outcomes of Percutaneous MitraClip Versus Surgical Repair or Replacement for Degenerative Mitral Regurgitation in Octogenarians

“…12 Notably, preoperative EF was conserved in the vast majority of patients: indeed, elderly patients are more frequently affected by DMR rather than functional MR; in this setting, left ventricle dysfunction is usually absent, whereas other features contribute to increase the risk profile (e.g., frailty). Despite this increased risk/worse-outcome profile, MitraClip therapy appears remarkably safe in the elderly population in terms of acute mortality and complications.…”

Strategies and Outcomes of Repeat Mitral Valve Interventions after Failed MitraClip Therapy

“…In the landmark EVEREST (Endovascular Valve Edge-to-Edge Repair Study) II trial [2], MitraClip intervention was noninferior to surgery with respect to the composite of freedom from all-cause mortality, surgery for mitral valve (MV) dysfunction or MR grade ≥3+ at 12 months, but 41 patients (23%) in the MitraClip arm had unsuccessful procedures (i.e., persistent MR grade ≥3+) and 28 of them required surgical reintervention before hospital discharge. Real-world registries, which generally include more patients with functional MR, also show that rates of MitraClip failure are not negligible [3] and that residual or relapsing severe MR is a strong prognostic determinant [4,5]. In light of the above, reintervention after failed MitraClip therapy is increasingly performed as a strategy to overcome the negative prognostic impact of untreated MR (Table 1) [2,6,7,8,9,10].…”