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

Abstract

Percutaneous mitral valve repair (PMVR) with the MitraClip system (Abbott Vascular, Santa Clara, CA, USA) is a valid therapeutic option for patients with severe mitral regurgitation (MR) deemed to be at high or prohibitive surgical risk. Despite the reassuring data on efficacy and long-term durability of the procedure, the proportion of patients with residual or relapsing severe MR after MitraClip therapy is not negligible. In light of the detrimental prognostic impact of severe MR, repeat interventions are increasingly performed in clinical practice using different techniques. In high-risk settings, percutaneous procedures have proven to be effective and safe at reducing MR. Building on this, we sought to summarize the current landscape and clinical experience of reinterventions after failed MitraClip therapy, so as to assist physicians facing the clinical hurdle of proper treatment management after failed PMVR.

Failed MitraClip therapy: surgical revision in high-risk patients

“…In 2007, the percutaneous mitral valve repair via the MitraClip system was introduced in clinical use for high-risk surgical patients [5, 6]. In these high-risk patients, percutaneous mitral valve intervention showed effective reduction of mitral regurgitation [7]. Several studies reported good short-term results after mitral clipping, while others compared mitral valve surgery with MitraClip procedures.…”

The PASCAL transcatheter mitral valve repair system for the treatment of mitral regurgitation: another piece to the puzzle of edge-to-edge technique

“…Remarkably, a specific challenge will be the result of PASCAL system in mitral valve with severe annular dilatation, for which MitraClip alone without annuloplasty did not showed satisfactory long-term results (15) and for which a combined therapy with multiple devices could be warranted (16). Addressing the theme of failure after TMVR, another point to determine will be the possibility to perform a repeat PASCAL procedure with respect to the mitral valve gradient in case of mitral regurgitation recurrence (17).…”