title: Mitral valve surgery in 6 patients after failed MitraClip therapy.
abstract: The MitraClip percutaneous mitral valve repair system, developed as an option for percutaneous mitral repair, was clinically introduced in 2007. From 2010 through 2012, 6 of our patients underwent mitral valve surgery after MitraClip failure. Their mean age was 75 ± 7.7 years (range, 62-87 yr). Three had undergone cardiac surgery previously. In 5 of the 6 patients, mitral regurgitation recurred after initially successful MitraClip deployment and was the indication for surgery. The mean interval between MitraClip implantation and surgery was 106 ± 86 days (range, 0-238 d). Mitral valve repair was feasible in 3 patients; the others underwent valve replacement. All the patients underwent additional cardiac procedures, because the MitraClip worsened existing conditions. Echocardiograms revealed sufficient valvular repairs. Two patients died during hospitalization, one of cerebral infarction and the other of bowel ischemia. Mitral valve repair after failed MitraClip therapy can be complex and a surgical challenge. Careful consideration should be given to appropriate patient selection for MitraClip therapy, because the MitraClip can cause existing pathologic valvular conditions to deteriorate substantially. The interval between MitraClip failure and corrective surgery should be as short as possible. The primary indication is an issue of ongoing discussion.
authors.forename: Nadejda
authors.initials: N
authors.lastname: Monsefi
authors.forename: Andreas
authors.initials: A
authors.lastname: Zierer
authors.forename: Mahmud
authors.initials: M
authors.lastname: Khalil
authors.forename: Mahmut
authors.initials: M
authors.lastname: Ay
authors.forename: Andres
authors.initials: A
authors.lastname: Beiras-Fernandez
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
authors.forename: Ulrich Alfred
authors.initials: UA
authors.lastname: Stock
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D005858:Germany; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D011183:Postoperative Complications / Q000401:mortality; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure
keywords: Equipment failure; heart valve prosthesis implantation/methods; mitral valve insufficiency/surgery; percutaneous coronary intervention/methods; prostheses and implants; surgical procedures, minimally invasive/adverse effects/instrumentation; time factors; treatment outcome; tricuspid valve/surgery