Residual versus recurrent mitral regurgitation after transcatheter mitral valve edge‐to‐edge repair

Abstract

Background The number of MtraClip procedures is increasing, and consequently, the number of patients with residual or recurrent mitral regurgitation (MR). We aimed to characterize patients who had residual versus recurrent MR after MitraClip and report the outcomes of different treatment strategies. Methods From 2012 to 2020, 167 patients had MitraClip. Out of them, 16 patients (9.5%) had residual mitral regurgitation (MR), and 27 patients (16.2%) had recurrent MR. Results The median age in patients with residual MR was 67.5 (59–73) years versus 69 (61–78) years in patients with recurrent MR (p = .87). The etiology of mitral valve disease was functional in 13 patients (81.3%) and 22 patients (84.6%) in residual versus recurrent MR patients (p > .99). Cardiac resynchronization therapy‐defibrillator implantation was higher in patients with residual MR (p = .02). Survival was 93.7% at 1 year, 76.4% at 3 years versus 92.5% at 1 year, and 84.5% at 3 years in residual versus recurrent MR (p = .69). Two patients in the residual MR group had re‐clip, and three had surgery, and in the recurrent MR group, one patient had re‐clip, and two patients had surgery (p = .23). Patients who had re‐clip were older (p = .09). Surgery was associated with 100% survival at 5 years, 63% after medical therapy and the worst survival was reported in re‐clip patients (p = .007). Conclusion The outcomes of patients with residual versus recurrent mitral regurgitation after MitraClip were comparable. Survival could be improved with surgery compared with medical therapy and re‐clip.

Dobutamine stress echocardiography during transcatheter edge‐to‐edge mitral valve repair predicts residual mitral regurgitation

“…This is associated with adverse outcome (increased risk of re-intervention for MR (surgical or transcatheter), ventricular assist device implantation and mortality) after TMVR. [3][4][5] MR can be a dynamic phenomenon that is, highly affected by anesthetic agents and variations in loading conditions. 13 Hence, there is a substantial risk that the severity is underestimated when the patient is under GA during surgical or transcatheter treatment.…”

“…Earlier studies show that significant residual MR is present in 10%–30% of patients at discharge, which is associated with long‐term recurrence of severe MR. This is associated with adverse outcome (increased risk of re‐intervention for MR (surgical or transcatheter), ventricular assist device implantation and mortality) after TMVR 3–5 . MR can be a dynamic phenomenon that is, highly affected by anesthetic agents and variations in loading conditions 13 .…”

“…During the procedure, MR can be reduced to ≤moderate in most patients 2 . However, at discharge transthoracic echocardiogram (TTE) >moderate MR is present in 10%–30% of patients 3–5 . The procedure is performed under general anesthesia (GA), which influences loading conditions, that could potentially lead to underestimation of MR, especially in those with a functional etiology 6 .…”

Cardiogenic Shock Secondary to Acute Mitral Regurgitation With Nonischemic Etiology Successfully Stabilized by Transcatheter Intervention

“…Limited institutional experience suggests that surgical approaches might improve outcomes compared with medical therapy and repeated TMVEER. 14 Therefore, close follow-up and careful surgical planning are critical in monitoring those patients with degenerative etiology after having TMVEER. Surgical repair late after TMVEER is attractive but technically challenging due to fibrotic remodeling around the attached area and structural distortion of the leaflets and subvalvular apparatus.…”

Transcatheter Mitral Valve Repair or Replacement: Competitive or Complementary?

“…In published data, the failure rate of MitraClip procedures ranged from 4.8% to 9.5%, and the recurrent MR rate was 5.1–21.5% [ 32 , 33 , 34 ]. EI-Shurafa et al [ 35 ] proposed that surgical intervention could be used to improve survival in patients with residual MR or recurrent MR after MitraClip procedure.…”