Mid-Term Results of Surgery in Patients with Unsuccessful MitraClip Implants for Degenerative Mitral Valve Disease

Objectives: To assess the results of open-heart operations in degenerative mitral valve disease after failed MitraClip therapy (Abbott Laboratories, Abbott Park, IL).

Methods: Between 2009 and 2019 we operated on 22 consecutive symptomatic patients (age: 76 ± 11 years, 7 females and 15 males) with degenerative mitral regurge after failure of interventions with 1 to 4 MitraClip implants. At the time of their operations, 0 to 1.238 days after clip insertions, patients had recurrent or persistent grade-3 mitral insufficiency. The calculated risk using the European System for Cardiac Operative Risk Evaluation (Logistic EuroSCORE) was 33.3 ± 20.4%.

Results: Mitral therapy comprised mitral valve repair in 13.6% of patients (n = 3) and biological valve replacement in 86.4% (n = 19). Concomitant tricuspid valve repair was performed in 10 patients (45.5%) and atrial fibrillation ablation was carried out in 11 (50%), respectively. All patients required closure of an iatrogenic atrial septal defect. Patients were discharged at median 16 days. Within 30 days there was one cardiac death (4.5%). At follow-up of median 4.7 years, 15 patients were still alive (68.2%). Six noncardiac deaths had occurred between day 156 and 1.577 after operations. The majority of midterm survivors was almost asymptomatic with a New York Heart Association functional class of I (11 patients) or II (four patients), respectively.

Conclusion: The data suggest that cardiac surgery in symptomatic patients with unsuccessful MitraClip implantations for degenerative mitral valve disease is a safe option that provides encouraging midterm results.