title: Surgical revision after percutaneous mitral valve repair with a clip: initial multicenter experience.
abstract: OBJECTIVE
  Almost 50,000 mitral valve operations are performed annually in the United States, with an increasing number of repairs. Recently, a percutaneous mitral valve repair option that achieves edge-to-edge approximation with a clip has been described in patients with mitral regurgitation.
  
  
  METHODS
  We describe 6 patients from three centers with mitral regurgitation after percutaneous repair who underwent reintervention. During open surgical revision, the clips were uneventfully removed in all patients with no limitation in surgical options. Five patients underwent repair and 1 underwent replacement.
  
  
  RESULTS
  After surgical revision, mitral regurgitation was significantly decreased, and all but 1 patient underwent uneventful recovery. One patient developed ilio-femoral deep venous thrombosis that was treated successfully with anticoagulation.
  
  
  CONCLUSIONS
  Preserving standard of care options is critical with any evolving technology in the event of initial treatment failure. Standard surgical options were preserved in all of the patients who underwent percutaneous mitral valve edge-to-edge repair. Furthermore, a thorough understanding of the clip design, in particular its unlocking mechanism, is essential and facilitates surgical clip removal.
authors.affiliation: Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA.
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Dang
authors.forename: Michael S
authors.initials: MS
authors.lastname: Aboodi
authors.forename: Taichi
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: Hal S
authors.initials: HS
authors.lastname: Wasserman
authors.forename: Michael
authors.initials: M
authors.lastname: Argenziano
authors.forename: Delos M
authors.initials: DM
authors.lastname: Cosgrove
authors.forename: Todd K
authors.initials: TK
authors.lastname: Rosengart
authors.forename: Ted
authors.initials: T
authors.lastname: Feldman
authors.forename: Peter C
authors.initials: PC
authors.lastname: Block
authors.forename: Mehmet C
authors.initials: MC
authors.lastname: Oz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation