Impact of MitraClip™ therapy on secondary mitral valve surgery in patients at high surgical risk
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Impact of MitraClip™ therapy on secondary mitral valve surgery in patients at high surgical risk. / Conradi, Lenard; Treede, Hendrik; Franzen, Olaf; Seiffert, Moritz; Baldus, Stephan; Schirmer, Johannes; Meinertz, Thomas; Reichenspurner, Hermann.
In: EUR J CARDIO-THORAC, Vol. 40, No. 6, 12.2011, p. 1521-1526.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Impact of MitraClip™ therapy on secondary mitral valve surgery in patients at high surgical risk
AU - Conradi, Lenard
AU - Treede, Hendrik
AU - Franzen, Olaf
AU - Seiffert, Moritz
AU - Baldus, Stephan
AU - Schirmer, Johannes
AU - Meinertz, Thomas
AU - Reichenspurner, Hermann
N1 - Copyright © 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
PY - 2011/12
Y1 - 2011/12
N2 - OBJECTIVE: Conventional or minimally invasive surgical mitral valve repair (MVR) is the gold-standard treatment for severe mitral regurgitation (MR) of any etiology. Given its good safety profile, trans-catheter MVR with the MitraClip™ device is used increasingly for high-risk or inoperable patients. We report our experience with failed MitraClip™ therapy and its impact on subsequent surgical strategies, such as the feasibility of MVR in high-risk patients.METHODS: During a follow-up of 344 ± 227 days from the first 215 consecutive patients treated with the MitraClip™ device, six patients required surgical re-intervention due to failed repair (n = 3) or recurrent severe MR (n = 3) at 35.8 ± 47.7 (range 0-117) days after trans-catheter MVR. Feasibility of secondary surgical MVR was assessed with regard to prior clip therapy.RESULTS: In three patients, secondary surgical MVR was successfully performed following the surgical strategy deemed optimal before trans-catheter treatment. Injury of the mitral leaflets caused by prior clip treatment was present in three other patients and influenced the surgical strategy toward more complex surgical techniques in one case and MV replacement in two others. One patient died 6 days after MV replacement. All other patients are alive with adequate valve function at the latest follow-up of 12.4 ± 7.4 months (range 4-22).CONCLUSIONS: Secondary surgical MVR was feasible in some patients after prior clip treatment, but led to valve replacement in others. At present, patient selection criteria for trans-catheter MVR should not be expanded toward more healthy patients, as primary trans-catheter MVR may complicate secondary surgery in certain cases and may even preclude reconstructive valve surgery.
AB - OBJECTIVE: Conventional or minimally invasive surgical mitral valve repair (MVR) is the gold-standard treatment for severe mitral regurgitation (MR) of any etiology. Given its good safety profile, trans-catheter MVR with the MitraClip™ device is used increasingly for high-risk or inoperable patients. We report our experience with failed MitraClip™ therapy and its impact on subsequent surgical strategies, such as the feasibility of MVR in high-risk patients.METHODS: During a follow-up of 344 ± 227 days from the first 215 consecutive patients treated with the MitraClip™ device, six patients required surgical re-intervention due to failed repair (n = 3) or recurrent severe MR (n = 3) at 35.8 ± 47.7 (range 0-117) days after trans-catheter MVR. Feasibility of secondary surgical MVR was assessed with regard to prior clip therapy.RESULTS: In three patients, secondary surgical MVR was successfully performed following the surgical strategy deemed optimal before trans-catheter treatment. Injury of the mitral leaflets caused by prior clip treatment was present in three other patients and influenced the surgical strategy toward more complex surgical techniques in one case and MV replacement in two others. One patient died 6 days after MV replacement. All other patients are alive with adequate valve function at the latest follow-up of 12.4 ± 7.4 months (range 4-22).CONCLUSIONS: Secondary surgical MVR was feasible in some patients after prior clip treatment, but led to valve replacement in others. At present, patient selection criteria for trans-catheter MVR should not be expanded toward more healthy patients, as primary trans-catheter MVR may complicate secondary surgery in certain cases and may even preclude reconstructive valve surgery.
KW - Aged
KW - Feasibility Studies
KW - Female
KW - Follow-Up Studies
KW - Heart Valve Prosthesis Implantation
KW - Humans
KW - Male
KW - Middle Aged
KW - Minimally Invasive Surgical Procedures/instrumentation
KW - Mitral Valve/surgery
KW - Mitral Valve Insufficiency/surgery
KW - Prostheses and Implants
KW - Prosthesis Failure
KW - Recurrence
KW - Reoperation/methods
U2 - 10.1016/j.ejcts.2011.03.007
DO - 10.1016/j.ejcts.2011.03.007
M3 - SCORING: Journal article
C2 - 21497508
VL - 40
SP - 1521
EP - 1526
JO - EUR J CARDIO-THORAC
JF - EUR J CARDIO-THORAC
SN - 1010-7940
IS - 6
ER -
