Surgical revision after percutaneous mitral repair with the MitraClip device.
BACKGROUND
Percutaneous mitral repair with the MitraClip device (Evalve, Menlo Park, CA) has been reported. Preserving conventional surgical options in the event of percutaneous treatment failure is important. We describe surgical treatment at varying intervals after the MitraClip procedure in 32 patients.


METHODS
One hundred seven patients with moderate-to-severe or severe mitral regurgitation who were either symptomatic (91%) or, if asymptomatic (9%), had evidence of left ventricular dysfunction were enrolled as part of the Endovascular Valve Edge-to-Edge REpair STudy (EVEREST) phase I registry study or as "roll-in" subjects in the EVEREST II study. Thirty-two of the 107 patients (30%) underwent surgery after an attempted MitraClip procedure.


RESULTS
Of the 32 patients undergoing post-clip mitral valve surgery, 23 patients (72%) had one or more clips implanted and 9 patients (28%) received no clip implant. The indications for mitral valve surgery in the 23 patients with a clip included partial clip detachment (n = 10), residual or recurrent mitral regurgitation greater than 2+ (n = 9), and other (atrial septal defect [n = 2], device malfunction [n = 1], and incorrectly diagnosed mitral stenosis [n = 1]). Twenty-seven of 31 patients (87%) underwent the surgical procedure planned before surgery (planned procedure unknown in 1 patient). Four of 25 patients (16%) with planned repair underwent mitral valve replacement.


CONCLUSIONS
Standard surgical options were preserved in patients who had surgery after percutaneous repair with the MitraClip device. Successful repair was feasible in the majority of patients after the MitraClip procedure, with repair performed as late as 18 months after clip implantation.
Argenziano
Michael
M
Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. ma66@columbia.edu
Skipper
Eric
E
Heimansohn
David
D
Letsou
George V
GV
Woo
Y Joseph
YJ
Kron
Irving
I
Alexander
John
J
Cleveland
Joseph
J
Kong
Bobby
B
Davidson
Michael
M
Vassiliades
Thomas
T
Krieger
Karl
K
Sako
Ed
E
Tibi
Pierre
P
Galloway
Aubrey
A
Foster
Elyse
E
Feldman
Ted
T
Glower
Donald
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation / Q000379:methods*; D013536:Suture Techniques / Q000295:instrumentation*; D013997:Time Factors; D017211:Treatment Failure