title: Repeat MitraClip Therapy for Significant Recurrent Mitral Regurgitation in High Surgical Risk Patients: Impact of Loss of Leaflet Insertion.
abstract: OBJECTIVE
  The goal of this study was to assess procedural details and outcomes of repeat MitraClip therapy.
  
  
  BACKGROUND
  MitraClip implantation is a safe and efficacious percutaneous approach to treat significant mitral regurgitation (MR).
  
  
  METHODS
  Of 410 inoperable or high surgical risk patients treated with the MitraClip at our institution, 17 (4.1%) patients, as well as 4 patients initially treated at external institutions, underwent repeat MitraClip procedures. Mean age of the 21 patients (14 men [67%]) was 77 years; 15 patients (71%) had functional MR.
  
  
  RESULTS
  Repeat procedures performed at a median of 6.3 months (range 0.7 to 34 months) after the index intervention were successful (discharge MR grade ≤2+) in 13 patients (62%), with a pronounced difference in success rate observed between the 13 patients with adequate leaflet insertion at the time of the repeat intervention and the 8 patients in whom loss of leaflet insertion (LLI) (leaflet tear/perforation or partial clip detachment) was present (11 of 13 [85%] vs. 2 of 8 [25%], respectively). The 21 patients were followed for a median of 8.5 (interquartile range: 2.3 to 18.6) months; 13 patients (62%), 8 with adequate leaflet insertion and 5 with LLI, died during follow-up.
  
  
  CONCLUSIONS
  Repeat MitraClip intervention for significant recurrent MR appears to be a viable therapeutic approach in patients in whom leaflet insertion into the MitraClip is not compromised. LLI is strongly associated with repeat procedural failure.
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg Hospital, Hamburg, Germany. Electronic address: f.kreidel@asklepios.com.
authors.forename: Felix
authors.initials: F
authors.lastname: Kreidel
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg Hospital, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Frerker
authors.affiliation: Asklepios Proresearch, Hamburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schlüter
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg Hospital, Hamburg, Germany.
authors.forename: Hannes
authors.initials: H
authors.lastname: Alessandrini
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg Hospital, Hamburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Thielsen
authors.affiliation: Department of Cardiac Surgery, Asklepios Klinik St. Georg Hospital, Hamburg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Geidel
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg Hospital, Hamburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schäfer
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg Hospital, Hamburg, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D004867:Equipment Design; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: MitraClip; mitral regurgitation; partial clip detachment; percutaneous mitral valve repair; repeat intervention