Repeat MitraClip Therapy for Significant Recurrent Mitral Regurgitation in High Surgical Risk Patients: Impact of Loss of Leaflet Insertion
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Repeat MitraClip Therapy for Significant Recurrent Mitral Regurgitation in High Surgical Risk Patients: Impact of Loss of Leaflet Insertion. / Kreidel, Felix; Frerker, Christian; Schlüter, Michael; Alessandrini, Hannes; Thielsen, Thomas; Geidel, Stephan; Schäfer, Ulrich; Kuck, Karl-Heinz.
in: JACC-CARDIOVASC INTE, Jahrgang 8, Nr. 11, 09.2015, S. 1480-1489.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Repeat MitraClip Therapy for Significant Recurrent Mitral Regurgitation in High Surgical Risk Patients: Impact of Loss of Leaflet Insertion
AU - Kreidel, Felix
AU - Frerker, Christian
AU - Schlüter, Michael
AU - Alessandrini, Hannes
AU - Thielsen, Thomas
AU - Geidel, Stephan
AU - Schäfer, Ulrich
AU - Kuck, Karl-Heinz
N1 - Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2015/9
Y1 - 2015/9
N2 - OBJECTIVES: 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.
AB - OBJECTIVES: 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.
KW - Aged
KW - Aged, 80 and over
KW - Cardiac Catheterization/adverse effects
KW - Echocardiography, Three-Dimensional
KW - Echocardiography, Transesophageal
KW - Equipment Design
KW - Female
KW - Germany
KW - Humans
KW - Male
KW - Mitral Valve/diagnostic imaging
KW - Mitral Valve Insufficiency/diagnosis
KW - Recurrence
KW - Retreatment
KW - Retrospective Studies
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1016/j.jcin.2015.06.019
DO - 10.1016/j.jcin.2015.06.019
M3 - SCORING: Journal article
C2 - 26404201
VL - 8
SP - 1480
EP - 1489
JO - JACC-CARDIOVASC INTE
JF - JACC-CARDIOVASC INTE
SN - 1936-8798
IS - 11
ER -
