Repeat MitraClip Therapy for Significant Recurrent Mitral Regurgitation in High Surgical Risk Patients: Impact of Loss of Leaflet Insertion

JACC Cardiovasc Interv. 2015 Sep;8(11):1480-1489. doi: 10.1016/j.jcin.2015.06.019.

Abstract

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.

Keywords: MitraClip; mitral regurgitation; partial clip detachment; percutaneous mitral valve repair; repeat intervention.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cardiac Catheterization / adverse effects
  • Cardiac Catheterization / instrumentation*
  • Echocardiography, Three-Dimensional
  • Echocardiography, Transesophageal
  • Equipment Design
  • Female
  • Germany
  • Humans
  • Male
  • Mitral Valve Insufficiency / diagnosis
  • Mitral Valve Insufficiency / physiopathology
  • Mitral Valve Insufficiency / therapy*
  • Mitral Valve* / diagnostic imaging
  • Mitral Valve* / physiopathology
  • Recurrence
  • Retreatment
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome