Surgical revision of failed percutaneous edge-to-edge mitral valve repair: lessons learned

Gyoten, Takayuki; Schenk, Sören; Rochor, Kristin; Harnath, Axel; Grimmig, Oliver; Just, Sören; Fritzsche, Dirk

doi:10.1093/icvts/ivy361

Cited by 21 publications

(24 citation statements)

References 15 publications

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“…The main finding of this study is the feasibility of mitral valve surgery in a highest risk patient cohort with a predominantly complex constellation of mixed degenerative/functional MR and significantly reduced left ventricular ejection fraction who were initially classified as high surgical risk and, therefore, inoperable (Table 2). Our results are in line with recent publications on post‐MC surgical bailout, in which feasibility of surgery with acceptable results were equally demonstrated 9,10 . Organ failure resulting from cardiogenic shock/sepsis as possible risk factor for perioperative mortality in our case and in the patient‐cohort recently presented by Takayuki et al 10 calls for close meshed monitoring of these patients and timely surgery if indicated and feasible.…”

Section: Discussionsupporting

confidence: 91%

“…Our results are in line with recent publications on post‐MC surgical bailout, in which feasibility of surgery with acceptable results were equally demonstrated 9,10 . Organ failure resulting from cardiogenic shock/sepsis as possible risk factor for perioperative mortality in our case and in the patient‐cohort recently presented by Takayuki et al 10 calls for close meshed monitoring of these patients and timely surgery if indicated and feasible.…”

Section: Discussionsupporting

confidence: 91%

“…This approach is supported by the fact that the overall impact of MC in secondary MR is yet to be irrevocably established 8 . Publications dealing with persistent or recurrent MR after MC intervention and subsequent management strategies in this often times difficult situation are increasing and need to be evaluated to better understand the future perspectives of catheter‐based MV intervention 9,10 . Factors guiding the decision as to whether to treat a case of failed MC intervention conservatively, catheter‐based or surgically is yet to be fully established.…”

Section: Introductionmentioning

confidence: 99%

“…8 Publications dealing with persistent or recurrent MR after MC intervention and subsequent management strategies in this often times difficult situation are increasing and need to be evaluated to better understand the future perspectives of catheterbased MV intervention. 9,10 Factors guiding the decision as to whether to treat a case of failed MC intervention conservatively, catheter-based or surgically is yet to be fully established. Therefore interdisciplinary heart-team approach should be of paramount importance in this early phase of a new technology.…”

Section: Introductionmentioning

confidence: 99%

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Surgical revision after percutaneous mitral valve repair by edge‐to‐edge device in high‐risk patients

et al. 2020

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Background: Patients scheduled for surgery after unsuccessful MitraClip® intervention present increasingly with multiple comorbidities, and they are often referred to the heart team to suggest the most appropriate intervention. The publication of successful results of initial patient cohorts treated with the MitraClip device has resulted in recruitment of more seriously ill patients, who otherwise would have been denied catheter-based/surgical treatment. There has been increasingly reports on conventional surgery after failed mitral valve repair with the MitraClip device. However, data on such procedures remain scarce and mostly focused on individual case studies. The inevitable increase in use of MitraClip, however, will raise the number of patients in need of surgery post MitraClip, making it imperative for surgeons to understand challenges and outcome data related with surgery in this patient cohort. We present our long-term institutional experience with surgery after MitraClip intervention in highest risk patients. Methods: Eighteen patients underwent surgery of the mitral valve at our Institution between January 2015 and June 2020. These patients developed recurrent mitral regurgitation grade more than 2°at various intervals after MitraClip. Mitral valve repair was performed where possible and gross examination Valve/MitraClip were intra-operatively documented. Implanted MitraClip devices were analyzed histopathologically to evaluate the healing process and rule out inflammation. Regular patient follow-up was performed. Results: Mean patient age was 74 (±9 years) and MitraClip implantation was performed at various tertiary institutions. Sixteen out of eighteen (16/18) patients received mitral valve replacement, whereas the remaining two patients received mitral valve repair and extracorporal membrane oxygenation, respectively. Four patients died of sepsis and intractable multi organ failure in-hospital. The remaining patients were discharged alive out of hospital to different rehabilitation centers. Follow-up was complete in all patients.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical revision after percutaneous mitral valve repair by edge‐to‐edge device in high‐risk patients

et al. 2020

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“…MitraClip single‐leaflet detachment (SLD) occurs in 1.0%–1.5% of procedures performed in the United States 1 . A number of case reports have addressed interventional and surgical approaches to this complication 2,3 . Despite these reports, there is a paucity of literature describing echocardiographic assessment of a partially detached MitraClip for procedural planning.…”

Section: Introductionmentioning

confidence: 99%

Incremental value of three‐dimensional transesophageal echocardiography over the two‐dimensional technique in the assessment of a partially detached MitraClip

et al. 2021

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MitraClip single-leaflet detachment (SLD) occurs in 1.0%-1.5% of procedures performed in the United States. 1 A number of case reports have addressed interventional and surgical approaches to this complication. 2,3 Despite these reports, there is a paucity of literature describing echocardiographic assessment of a partially detached MitraClip for procedural planning. In particular, to the best of our knowledge, no report has described the incremental value of live/real-time three-dimensional transesophageal echocardiography (3DTEE) over traditional two-dimensional transesophageal echocardiography (2DTEE) in the evaluation of a partially detached MitraClip. In the present study, we describe an elderly patient with previous placement of two MitraClips, one fixed and the other partially detached, in whom 3DTEE proved most useful and provided additional information compared to 2DTEE in the assessment of this complication.

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Surgical revision of failed MitraClip procedure for atrial functional mitral regurgitation

Inaba¹,

Iida²,

Oka³

et al. 2021

J Artif Organs

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Surgical revision of failed percutaneous edge-to-edge mitral valve repair: lessons learned

Cited by 21 publications

References 15 publications

Surgical revision after percutaneous mitral valve repair by edge‐to‐edge device in high‐risk patients

Surgical revision after percutaneous mitral valve repair by edge‐to‐edge device in high‐risk patients

Incremental value of three‐dimensional transesophageal echocardiography over the two‐dimensional technique in the assessment of a partially detached MitraClip

Surgical revision of failed MitraClip procedure for atrial functional mitral regurgitation

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