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Pizano A, Riojas R, Ailawadi G, Smith RL, George T, Gerdisch MW, Di Eusanio M, Castillo-Sang M, Ramlawi B, Rodriguez E, Morse MA, Doolabh NS, Jessen ME, Wei L, Chu MWA, Berretta P, Cura Stura E, Salizzoni S, Rinaldi M, Kaneko T, Tang GHL, Chikwe J, Roach A, Trento A, Badhwar V, Nguyen TC. Minimally Invasive Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:42-49. [PMID: 35225065 DOI: 10.1177/15569845211070568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Up to 28% of patients may need mitral valve (MV) surgery after transcatheter edge-to-edge repair (TEER). This study evaluates the outcomes of minimally invasive MV surgery after TEER. Methods: International multicenter registry of minimally invasive MV surgery after TEER between 2013 and 2020. Subgroups were stratified by the number of devices implanted (≤1 vs >1), as well as time interval from TEER to surgery (≤1 year vs >1 year). Results: A total of 56 patients across 13 centers were included with a mean age of 73 ± 11 years, and 50% were female. The median Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) score for MV replacement was 8% (Q1-Q3 = 5% to 11%) and the ratio of observed to expected mortality was 0.9. The etiology of mitral regurgitation (MR) prior to TEER was primary MR in 75% of patients and secondary MR in 25%. There were 30 patients (54%) who had >1 device implanted. The median time between TEER and surgery was 252 days (33 to 636 days). Hemodynamics, including MR severity, MV area, and mean gradient, significantly improved after minimally invasive surgery and sustained to 1-year follow-up. In-hospital and 30-day mortality was 7.1%, and 1-year actuarial survival was 85.6% ± 6%. Conclusions: Minimally invasive MV surgery after TEER may be achieved as predicted by the STS PROM. Most patients underwent MV replacement instead of repair. As TEER is applied more widely, patients should be informed about the potential need for surgical intervention over time after TEER. These discussions will allow better informed consent and post-procedure planning.
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Affiliation(s)
- Alejandro Pizano
- 12340The University of Texas Health Science Center at Houston, TX, USA
| | - Ramon Riojas
- 8785University of California San Francisco, CA, USA
| | - Gorav Ailawadi
- 12266The University of Michigan Medical School, Ann Arbor, MI, USA
| | - Robert L Smith
- 469050Baylor Scott & White Heart and Vascular Hospital, Dallas, TX, USA
| | - Timothy George
- 469050Baylor Scott & White Heart and Vascular Hospital, Dallas, TX, USA
| | | | - Marco Di Eusanio
- Lancisi Cardiovascular Center-OORR, 9294Polytechnic University of Marche, Ancona, Italy
| | | | | | | | | | - Neelan S Doolabh
- 12334University of Texas Southwestern Medical Center at Dallas, TX, USA
| | - Michael E Jessen
- 12334University of Texas Southwestern Medical Center at Dallas, TX, USA
| | - Lawrence Wei
- 5631West Virginia University, Morgantown, WV, USA
| | - Michael W A Chu
- Lawson Health Sciences Centre, Western University, London, Canada
| | - Paolo Berretta
- Lancisi Cardiovascular Center-OORR, 9294Polytechnic University of Marche, Ancona, Italy
| | - Erik Cura Stura
- 18691University of Turin-Città della Salute e della Scienza, Torino, Italy
| | - Stefano Salizzoni
- 18691University of Turin-Città della Salute e della Scienza, Torino, Italy
| | - Mauro Rinaldi
- 18691University of Turin-Città della Salute e della Scienza, Torino, Italy
| | - Tsuyoshi Kaneko
- 1861Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Joanna Chikwe
- 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Amy Roach
- 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Tom C Nguyen
- 8785University of California San Francisco, CA, USA
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2
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Pingpoh C, Kreibich M, Berger T, Thoma M, Beyersdorf F, Comberg T, Fagu A, Siepe M, Czerny M. Clinical Outcomes after Mitral Valve Surgery in Failed MitraClip Procedures. Thorac Cardiovasc Surg 2022; 71:165-170. [PMID: 35213930 DOI: 10.1055/s-0042-1742757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND We retrospectively evaluated in-hospital and overall outcome of patients who received mitral valve replacement (MVR) after failed MitraClip procedure. METHODS A total of 26 out of 740 patients received MVR after treatment with MitraClip between June 2010 and December 2020. We analyzed in-hospital mortality and overall mortality during the median follow-up period of 72 days after MVR. RESULTS The median age in the entire cohort was 77.5 years. In-hospital mortality was 15.4% (n = 4) and the overall mortality during the follow-up period was 27% (n = 7). The median time between the MitraClip procedure and surgery was 34.5 days. The main reasons for surgery were mitral stenosis (23.1%), persistent prolapse of the mitral valve leaflets (42.3%), and persistent tethering of the mitral valve leaflets (34.6%). At the time of surgery all of the patients presented with New York Heart Association 3 and above. The underlying mitral valve pathology was mainly secondary 61.5% (n = 16). Median left ventricular end-diastolic diameter was 60 mm. Preoperative ejection fraction was 40% and above in 73% of the cohort. In addition to the mitral valve procedure, 57.7% of patients received either concomitant tricuspid annuloplasty, aortic valve surgery, ascending aortic replacement, or coronary artery bypass grafting. CONCLUSION The need for MVR for failed MitraClip repair is low and the results are acceptable. However, remaining options for reconstruction are usually limited and MVR is often needed. Anticipating success or failure according to the underlying pathology more than according to concomitant risk factors should form the basis in decision making for the treatment modality of first choice.
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Affiliation(s)
- Clarence Pingpoh
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Maximillian Kreibich
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Tim Berger
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Martin Thoma
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Thomas Comberg
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Albi Fagu
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
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Melillo F, Baldetti L, Beneduce A, Agricola E, Margonato A, Godino C. Mitral valve surgery after a failed MitraClip procedure. Interact Cardiovasc Thorac Surg 2021; 32:380-385. [PMID: 33221925 DOI: 10.1093/icvts/ivaa270] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/03/2020] [Accepted: 09/27/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Among patients undergoing transcatheter mitral valve repair with the MitraClip device, a relevant proportion (2-6%) requires open mitral valve surgery within 1 year after unsuccessful clip implantation. The goal of this review is to pool data from different reports to provide a comprehensive overview of mitral valve surgery outcomes after the MitraClip procedure and estimate in-hospital and follow-up mortality. METHODS All published clinical studies reporting on surgical intervention for a failed MitraClip procedure were evaluated for inclusion in this meta-analysis. The primary study outcome was in-hospital mortality. Secondary outcomes were in-hospital adverse events and follow-up mortality. Pooled estimate rates and 95% confidence intervals (CIs) of study outcomes were calculated using a DerSimionian-Laird binary random-effects model. To assess heterogeneity across studies, we used the Cochrane Q statistic to compute I2 values. RESULTS Overall, 20 reports were included, comprising 172 patients. Mean age was 70.5 years (95% CI 67.2-73.7 years). The underlying mitral valve disease was functional mitral regurgitation in 50% and degenerative mitral regurgitation in 49% of cases. The indication for surgery was persistent or recurrent mitral regurgitation (grade >2) in 93% of patients, whereas 6% of patients presented with mitral stenosis. At the time of the operation, 80% of patients presented in New York Heart Association functional class III-IV. Despite favourable intraoperative results, in-hospital mortality was 15%. The rate of periprocedural cerebrovascular accidents was 6%. At a mean follow-up of 12 months, all-cause death was 26.5%. Mitral valve replacement was most commonly required because the possibility of valve repair was jeopardized, likely due to severe valve injury after clip implantation. CONCLUSIONS Surgical intervention after failed transcatheter mitral valve intervention is burdened by high in-hospital and 1-year mortality, which reflects reflecting the high-risk baseline profile of the patients. Mitral valve replacement is usually required due to leaflet injury.
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Affiliation(s)
- Francesco Melillo
- Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy
| | - Luca Baldetti
- Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy
| | | | - Eustachio Agricola
- Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Margonato
- Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Cosmo Godino
- Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy
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Ostovar R, Erb M, Schroeter F, Zytowski M, Kuehnel RU, Hartrumpf M, Albes JM. MitraClip: a word of caution regarding an all too liberal indication and delayed referral to surgery in case of failure. Eur J Cardiothorac Surg 2021; 59:887-893. [PMID: 33367523 DOI: 10.1093/ejcts/ezaa444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/06/2020] [Accepted: 10/18/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Although indications for the MitraClip are becoming increasingly liberal, the number of patients requiring valve surgery after an insufficient outcome of the procedure is growing. Referral to surgery is, however, frequently delayed. During this time, the patients often deteriorate. We retrospectively analysed patients before MitraClip implantation and after mitral valve surgery. METHODS A total of 49 patients who received a mitral valve replacement (average 8 ± 12 months after MitraClip implantation) were assessed. Of these, 53% had 2-4 clips inserted. The mean age was 73 years, and the mean log EuroSCORE was 20.79 ± 14.42%. Echocardiographic data obtained prior to MitraClip implantation and preoperatively, 10 days and 6 and 12 months after cardiac surgery were reviewed. Survival analysis, risk profile and postoperative complications were analysed. RESULTS The 30-day and 1-year mortality was 26.5% and 59.2%, respectively. Prior to MitraClip implantation, 42.8% of patients had mild tricuspid insufficiency and 6.1% had moderate tricuspid insufficiency. Prior to surgery, 26.5% showed mild, 32.7% moderate and 38.8% severe tricuspid insufficiency (P < 0.001). Furthermore, right heart function assessed by tricuspid annular plane systolic excursion deteriorated significantly after Implantation of the MitraClip (P < 0.001). In patients with a MitraClip, the pulmonary artery pressure was significantly higher at the time of mitral replacement than it was before the MitraClip was implanted (P < 0.001). CONCLUSIONS A subgroup of patients does not benefit from a MitraClip and shows progressive deterioration in cardiac function, making valve replacement under difficult circumstances inevitable. The earlier these patients are operated on, the better it is. It can be assumed that some patients would be better off with primary surgery, especially if mitral reconstruction is then still feasible. Therefore, the indications for MitraClip implantation should be carefully considered and caution should be exercised during monitoring.
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Affiliation(s)
- Roya Ostovar
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Bernau, Germany
| | - Michael Erb
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Bernau, Germany
| | - Filip Schroeter
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Bernau, Germany
| | - Michael Zytowski
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Bernau, Germany
| | - Ralf-Uwe Kuehnel
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Bernau, Germany
| | - Martin Hartrumpf
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Bernau, Germany
| | - Johannes Maximilian Albes
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Bernau, Germany
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Mazur P, Mok S, Krishnaswamy A, Kapadia S, Navia JL. Mitral valve surgery following failed MitraClip implantation. J Card Surg 2016; 32:14-25. [DOI: 10.1111/jocs.12877] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Piotr Mazur
- Department of Thoracic and Cardiovascular Surgery; Heart and Vascular Institute; Cleveland Clinic; Cleveland Ohio
- Institute of Cardiology; Jagiellonian University Medical College; Krakow Poland
| | - Salvior Mok
- Department of Thoracic and Cardiovascular Surgery; Heart and Vascular Institute; Cleveland Clinic; Cleveland Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine; Heart and Vascular Institute; Cleveland Clinic Cleveland Ohio
| | - Samir Kapadia
- Department of Cardiovascular Medicine; Heart and Vascular Institute; Cleveland Clinic Cleveland Ohio
| | - Jose L. Navia
- Department of Thoracic and Cardiovascular Surgery; Heart and Vascular Institute; Cleveland Clinic; Cleveland Ohio
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6
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Geidel S, Wohlmuth P, Schmoeckel M. Survival Prediction in Patients Undergoing Open-Heart Mitral Valve Operation After Previous Failed MitraClip Procedures. Ann Thorac Surg 2016; 101:952-8. [DOI: 10.1016/j.athoracsur.2015.08.086] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 07/06/2015] [Accepted: 08/26/2015] [Indexed: 10/22/2022]
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7
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Calafiore AM, Al Abdullah M, Iaco AL, Shah A, Ali Sheikh A, Allam A, Kheirallah H, Awadi MO, Di Mauro M. Mitral Valve Replacement After Mitraclip Therapy. J Card Surg 2015; 30:414-8. [DOI: 10.1111/jocs.12540] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Moheeb Al Abdullah
- Department of Adult Cardiology; Prince Sultan Cardiac Center; Riyadh Saudi Arabia
| | - Angela Lorena Iaco
- Department of Adult Cardiac Surgery; Prince Sultan Cardiac Center; Riyadh Saudi Arabia
| | - Aijaz Shah
- Department of Adult Cardiology; Prince Sultan Cardiac Center; Riyadh Saudi Arabia
| | - Azmat Ali Sheikh
- Department of Research; Prince Sultan Cardiac Center; Riyadh Saudi Arabia
| | | | - Hatim Kheirallah
- Department of Research; Prince Sultan Cardiac Center; Riyadh Saudi Arabia
| | | | - Michele Di Mauro
- Department of Heart Disease; University of L'Aquila; L'Aquila Italy
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8
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Alozie A, Westphal B, Kische S, Kaminski A, Paranskaya L, Bozdag-Turan I, Ortak J, Schubert J, Steinhoff G, Ince H. Surgical revision after percutaneous mitral valve repair by edge-to-edge device: when the strategy fails in the highest risk surgical population. Eur J Cardiothorac Surg 2013; 46:55-60. [DOI: 10.1093/ejcts/ezt535] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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9
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Geidel S, Schmoeckel M. Impact of failed mitral clipping on subsequent mitral valve operations. Ann Thorac Surg 2013; 97:56-63. [PMID: 24075487 DOI: 10.1016/j.athoracsur.2013.07.038] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/09/2013] [Accepted: 07/11/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study analyzed the effect of failed percutaneous mitral intervention with the MitraClip device (Abbott Laboratories, Abbott Park, IL) on subsequent mitral valve (MV) operations. METHODS Nineteen patients (74 ± 9 years) with treatment failure after implantation of 37 MitraClips (mean, 1.9 ± 0.8; range, 1 to 4) for functional or degenerative MV disease underwent operations a median of 12 days later (range, 0 to 546 days). All patients were studied before and after the operation by clinical investigation and echocardiographic analysis. Intraoperative findings and the effect on the operation were analyzed and are described in detail. Data before clipping and at the time of operation were compared, and the surgical outcome was recorded. RESULTS There was a significant increase in risk between that at the time of clipping and that at subsequent operations, noted as a rise of the European System for Cardiac Operative Risk Evaluation II from a median 12.74% to 26.87%, respectively (p < 0.0001, Wilcoxon signed rank test). Severe clip implantation-induced tissue damage was found in most patients. Surgical MV repair could be performed in 5 of 6 patients (83%) with a 1-clip implant and in only 3 of 13 patients (23%) when 2 or more clips had been inserted (p = 0.0188, Wilcoxon-Mann-Whitney test). All patients required other associated procedures: closure of an artificial atrial septal defect that was caused by the clipping procedure (100%), tricuspid valve repair (37%), atrial fibrillation ablation operations (37%), coronary artery bypass grafting (16%), and aortic valve replacement (11%). Two early cardiac deaths (< 30 days) occurred. Survival at 1 year was 68%. CONCLUSIONS There is a remarkable impact of failed clipping procedures on MV operations. We observed a severely aggravated cardiac pathology in parallel with a reduced preoperative clinical state compared with the original condition. Moreover, the likelihood of an optimal surgical solution with valve reconstruction was reduced thereafter. However, operations in the critical situation of an unsuccessful mitral clipping procedure should be discussed immediately, because it still seems to be an option compared with conservative therapy.
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Affiliation(s)
- Stephan Geidel
- Asklepios Kliniken St. Georg/Eimsbüttel, Abteilung für Herzchirurgie, Hamburg, Germany.
| | - Michael Schmoeckel
- Asklepios Kliniken St. Georg/Eimsbüttel, Abteilung für Herzchirurgie, Hamburg, Germany
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