Surgical revision after percutaneous mitral valve repair by edge-to-edge device: when the strategy fails in the highest risk surgical population

Abstract

Our series demonstrate that highest risk patients can survive mitral valve surgery after failed multiple edge-to-edge interventional mitral valve repair. As long-term results of the MitraClip therapy are pending, we recommend close meshed follow-up of patients treated with the MitraClip device, especially within the first year of the index procedure as delays in salvage management, interventional or surgical, when the index procedure fails may increase morbidity and mortality.

Infective endocarditis following transcatheter edge‐to‐edge mitral valve repair: A systematic review

“…The reported rate of IE following MitraClip has ranged from 0% to 1.3% (Figure ), in line with the surgical double‐orifice edge‐to‐edge technique, although most of the randomized controlled trials and large international registries conducted to date with the MitraClip device have failed to address the occurrence of IE . The low rates of IE observed after both transcatheter and surgical edge‐to‐edge mitral valve repair may be explained by the use of isolated clips or sutures, respectively, thus reducing the amount of foreign body material.…”

“…A total of 10 publications describing 12 cases of IE following percutaneous edge-to-edge mitral valve repair were identified [8][9][10][11][12][13][14][15][16][17]. All cases were published between 2011 and 2017.…”

“…The reported rate of IE following MitraClip has ranged from 0% to 1.3% [11,[25][26][27][28][29] (Figure 3 Most patients included in the present study had a high burden of comorbidities, such as cerebrovascular disease or advanced chronic kidney disease, the latter well-recognized as a predisposing factor for IE [35]. In fact, the mean logistic EuroSCORE was >40%, which expresses the extreme risk of the patients suffering from IE post-MitraClip therapy.…”

Mitral valve surgery following failed MitraClip implantation

“…In one case, the bioprosthetic transcatheter valve and an Amplatzer device had to be surgically removed . In four patients (4%), the MV had to be replaced after MCI due to infective endocarditis causing severe MR …”

An extremely rare but possible complication of MitraClip: embolization of clip during follow-up

“…The other case was that of a patient treated with surgery immediately after MitraClip implantation due to clip embolization. During surgery, one of the implanted MitraClips was not found on the valve and was detected in the renal artery (8). …”